{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T03:00:35Z","timestamp":1773284435000,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T00:00:00Z","timestamp":1554422400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T00:00:00Z","timestamp":1554422400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,8,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The standardized approach with triple diagnostics (surgical exploration with visual inspection, microbiological and histological examination) has been proposed as the golden standard for early diagnosis of severe necrotizing soft tissue disease (SNSTD, or necrotizing fasciitis) in ambivalent cases. This study's primary aim was to evaluate the protocolized approach after implementation for diagnosing (early) SNSTD and relate this to clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort study analyzing a 5\u2010year period was performed. All patients undergoing surgical exploration (with triple diagnostics) for suspected SNSTD since implementation were prospectively identified. Demographics, laboratory results and clinical outcomes were collected and analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>Thirty\u2010six patients underwent surgical exploration with eight (22%) negative explorations. The overall 30\u2010day mortality rate was 25%, with an early, SNSTD\u2010related mortality rate of 11% (<jats:italic>n<\/jats:italic>\u2009=\u20093). Of these, one patient (4%) underwent primary amputation, but died during surgery. No significant differences between baseline characteristics were found between patients diagnosed with SNSTD in early\/indistinctive or late\/obvious stage. Patient diagnosed at an early stage had a significantly shorter ICU stay (2 vs. 6\u00a0days, <jats:italic>p<\/jats:italic>\u2009=\u20090.031). Mortality did not differ between groups; patients who died were all ASA IV patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Diagnosing SNSTD using the approach with triple diagnostics resulted in a low mortality rate and only a single amputation in a pre\u2010terminal patient in the first 5 years after implementation. All deceased patients had multiple preexisting comorbidities consisting of severe systemic diseases, such as end\u2010stage heart failure. Early detection proved to facilitate faster recovery with shorter ICU stay.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-04999-9","type":"journal-article","created":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T17:13:56Z","timestamp":1554484436000},"page":"1898-1905","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A 5\u2010Year Evaluation of the Implementation of Triple Diagnostics for Early Detection of Severe Necrotizing Soft Tissue Disease: A Single\u2010Center Cohort Study"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8390-4483","authenticated-orcid":false,"given":"Femke","family":"Nawijn","sequence":"first","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roderick M.","family":"Houwert","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karlijn P. J.","family":"van Wessem","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rogier K. J.","family":"Simmermacher","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geertje A. M.","family":"Govaert","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marijke R.","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Pathology University Medical Center Utrecht Heidelberglaan 100 Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam B.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivar G. 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H.","family":"Leenen","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Falco","family":"Hietbrink","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,4,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2014.00036"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1067\/j.cpsurg.2014.06.001"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2017.00005"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318232a6b3"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010016\u20100108\u2010z"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1086\/511638"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9371"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002774"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000129486.35458.7D"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198406283102601"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2011.10.002"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611\u2010199711000\u201000001"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.2018.1398049"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco\u20102018\u2010000272"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010016\u20100080\u20107"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268809002532"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2017.173"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2014.05.006"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/BCR.0b013e318198a241"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-019-04999-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-019-04999-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-019-04999-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-019-04999-9","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,7]],"date-time":"2024-01-07T15:59:31Z","timestamp":1704643171000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-019-04999-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,5]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2019,8,15]]}},"alternative-id":["10.1007\/s00268-019-04999-9"],"URL":"https:\/\/doi.org\/10.1007\/s00268-019-04999-9","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,5]]},"assertion":[{"value":"5 April 2019","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"All authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The institutional review board of University Medical Center Utrecht provided a waiver for retrospective data collection.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}