TY - JOUR

T1 - Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family

T2 - a qualitative Nordic multi-center study

AU - Erichsen Andersson, Annette

AU - Egerod, Ingrid

AU - Knudsen, Vibeke E

AU - Fagerdahl, Ann-Mari

PY - 2018

Y1 - 2018

N2 - BACKGROUND: Necrotizing soft tissue infection is the most serious of all soft tissue infections. The patient's life is dependent on prompt diagnosis and aggressive treatment. Diagnostic delays are related to increased morbidity and mortality, and the risk of under- or missed diagnosis is high due to the rarity of the condition. There is a paucity of knowledge regarding early indications of disease. The aim of the study has thus been to explore patients' and families' experiences of early signs and symptoms and to describe their initial contact with the healthcare system.METHODS: A qualitative explorative design was used to gain more knowledge about the experience of early signs and symptoms. Fifty-three participants from three study sites were interviewed. The framework method was used for data analysis.RESULTS: Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. The experience of illness varied among the participants depending on the duration of antecedent signs and symptoms. Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear.CONCLUSION: Our study adds to the understanding of the lived experience of NSTI by providing in-depth description of antecedent signs and symptoms precipitating NSTI-diagnosis. We have described diagnostic delay as patient-related, primary care related, or hospital related and recommend that patient and family narratives should be considered when diagnosing NSTI to decrease diagnostic delay.

AB - BACKGROUND: Necrotizing soft tissue infection is the most serious of all soft tissue infections. The patient's life is dependent on prompt diagnosis and aggressive treatment. Diagnostic delays are related to increased morbidity and mortality, and the risk of under- or missed diagnosis is high due to the rarity of the condition. There is a paucity of knowledge regarding early indications of disease. The aim of the study has thus been to explore patients' and families' experiences of early signs and symptoms and to describe their initial contact with the healthcare system.METHODS: A qualitative explorative design was used to gain more knowledge about the experience of early signs and symptoms. Fifty-three participants from three study sites were interviewed. The framework method was used for data analysis.RESULTS: Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. The experience of illness varied among the participants depending on the duration of antecedent signs and symptoms. Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear.CONCLUSION: Our study adds to the understanding of the lived experience of NSTI by providing in-depth description of antecedent signs and symptoms precipitating NSTI-diagnosis. We have described diagnostic delay as patient-related, primary care related, or hospital related and recommend that patient and family narratives should be considered when diagnosing NSTI to decrease diagnostic delay.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Delayed Diagnosis/statistics & numerical data

KW - Denmark/epidemiology

KW - Diagnostic Errors/statistics & numerical data

KW - Family

KW - Fasciitis, Necrotizing/diagnosis

KW - Female

KW - Humans

KW - Interviews as Topic

KW - Male

KW - Middle Aged

KW - Narration

KW - Prodromal Symptoms

KW - Soft Tissue Infections/diagnosis

KW - Surveys and Questionnaires

KW - Survivors/statistics & numerical data

KW - Sweden/epidemiology

U2 - 10.1186/s12879-018-3355-7

DO - 10.1186/s12879-018-3355-7

M3 - Journal article

C2 - 30153808

VL - 18

SP - 429

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

SN - 1471-2334

IS - 1

ER -