Bullous Skin Signs and Laboratory Surgical Indicators Can Quickly and Effectively Differentiate Necrotizing Fasciitis From Cellulitis: Running title: NF and cellulitis differentiation

The purpose of this prospective study was to investigate the different micro-organisms associated with mortality, to evaluate the bullous skin sign, and to identify the positive predictive factors for differentiating necrotizing fasciitis from cellulitis on initial onset at emergency department.This prospective study was conducted in 145 consecutive NF patients and 159 cellulitis patients. Age, gender, comorbidities, infection site, microbiological results, condition of skin lesions, laboratory findings, vital signs, and clinical outcomes were compared between the two groups at the time of admission to emergency room.Fifteen patients of NF group and two patients of cellulitis group died, resulting in a mortality rate of 10.3% and 1.3% respectively. NF group had a significantly higher incidence of white blood cell (WBC) counts, band form neutrophil, and C-reactive protein (CRP) than the patients of cellulitis group. Hemorrhagic bullae presentation appeared to have significantly associated with the necrotizing fasciitis and death.THE FOLLOWING DIAGNOSTIC INDICATORS: : presence of hemorrhagic bullae, WBC counts11000 cells/mm