Abstract:
Background: Necrotizing fasciitis (NF) is a rapidly progressive, life-
threatening soft tissue infection with high mortality rates. Early
diagnosis and prompt surgical intervention are crucial for survival, yet
the initial diagnosis remains challenging due to nonspecific early
presentations. This study evaluated the diagnostic accuracy of point-of-
care ultrasound (POCUS) in identifying NF and its utility in guiding
clinical management decisions.
Methods: This prospective observational study included 85 patients
with suspected NF at a tertiary care center in India from April 2023 to
April 2025. Trained emergency physicians performed POCUS
examinations using high-frequency linear transducers and low-frequency
curvilinear transducers when necessary. Sonographic findings were
documented and correlated with surgical observations, clinical
outcomes, and laboratory parameters. Primary outcomes included
POCUS diagnostic accuracy, need for surgical intervention, and
mortality rates.
Results: The study population had a mean age of 50.2 years, with male
predominance (62.4%) and primarily lower limb involvement (77.6%).
POCUS demonstrated high positivity (97.6%) with predominantly fluid
collection (77.6%), loss of vascularity (65.9%), and fascial thickening
(52.9%). Sensitivity was highest for fascial thickening (97.1%) and fluid
collection (92.5%). The majority required multiple debridements
(83.5%), with 43.5% undergoing three procedures. At three-week
follow-up, 25.9% achieved partial recovery and 18.8% complete
recovery, with 15.3% mortality. Complications included amputation
(11.8%), sepsis (9.4%), and wound infection (8.2%). POCUS
assessment at three weeks showed persistent changes in 36.5% of
patients despite clinical improvement in many cases.
Conclusion: POCUS is a highly sensitive diagnostic tool for NF with
excellent correlation to surgical findings. Its immediate availability, non-
Invasive nature and repeatability position it as a valuable adjunct in the
initial assessment and monitoring of this life-threatening condition.
Integration of POCUS into standard assessment protocols for suspected
NF can potentially expedite diagnosis, guide surgical interventions, and
improve clinical outcomes.
