A study on accuracy of “point of care ultrasound” in diagnosing and management of necrotizing fasciitis

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.