The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study

Introduction Over the last five years, the American Association for the Surgery of Trauma (AAST) has developed grading scales for Emergency General Surgery (EGS) diseases. In a prior 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 (STI). Methods This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics and outcomes such as mortality, overall complications, 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 LRINEC 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. Study Type Prognostic/Epidemiologic retrospective multicenter trial Level of Evidence III Presented at the 78th Annual Meeting of the American Association for the Surgery of Trauma, San Diego, CA, 21 September, 2018. Address for Correspondence and Reprints: Stephanie A. Savage, MD, MS, Indiana University School of Medicine, 1604 N. Capitol Ave, Suite B253, Indianapolis, IN 46202, (317) 962-2093, stasava@iupui.edu There are no conflicts of interest related to this manuscript. Dr. Cox was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant #UL1 TR001860, and by the Agency for Healthcare Research and Quality through grant #T32HS022236. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ. There are no other financial disclosures related to this manuscript. © 2018 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://bit.ly/2VjUme3