Optimal timing of initial debridement for necrotizing soft tissue infection: A practice management guideline from the Eastern Association for the Surgery of Trauma

ABSTRACTBackgroundNecrotizing soft tissue infections (NSTI) are rare, life-threatening, soft-tissue infections characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous fat, and fascia. While it is widely accepted that delay in surgical debridement contributes to increased mortality, there are currently no practice management guidelines regarding the optimal timing of surgical management of this condition. Although debridement within 24 hours of diagnosis is generally recommended, the time ranges from 3 hours to 36 hours in the existing literature. Therefore, the objective of this article is to provide evidence-based recommendations for the optimal timing of surgical management of NSTI.MethodsThe MEDLINE database using PubMed was searched to identify English language articles published from January 1990 to September 2015 regarding adult and pediatric patients with necrotizing soft tissue infections. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was employed. A single PICO question was applied: In patients with necrotizing soft tissue infection (P), should early (

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