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The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study
- Source :
- The journal of trauma and acute care surgery, vol 86, iss 4
- Publication Year :
- 2019
-
Abstract
- Introduction Over the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs). Methods This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability. Results 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well. Conclusion This validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes. Level of evidence Prognostic/Epidemiologic retrospective multicenter trial, level III.
- Subjects :
- Male
Disease
Cardiorespiratory Medicine and Haematology
Critical Care and Intensive Care Medicine
Logistic regression
0302 clinical medicine
Postoperative Complications
Epidemiology
Medicine
Fasciitis
Skin Diseases, Infectious
Observer Variation
Infectious
Middle Aged
Prognosis
Abscess
Survival Rate
Infectious Diseases
Female
Patient Safety
Risk assessment
Adult
medicine.medical_specialty
necrotizing fasciitis
Clinical Sciences
Nursing
Skin Diseases
Risk Assessment
Article
03 medical and health sciences
Necrosis
Clinical Research
skin and soft-tissue infections
Internal medicine
Multicenter trial
Humans
Survival rate
Grading (tumors)
Emergency Treatment
Aged
Retrospective Studies
business.industry
Prevention
Soft Tissue Infections
LRINEC score
030208 emergency & critical care medicine
Retrospective cohort study
Cellulitis
Length of Stay
EGS grading scales
Emergency & Critical Care Medicine
United States
Good Health and Well Being
General Surgery
Surgery
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- The journal of trauma and acute care surgery, vol 86, iss 4
- Accession number :
- edsair.doi.dedup.....2e5fd76e2081d05c49e4eb9c38796ebd