{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:47:56Z","timestamp":1783338476873,"version":"3.54.6"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,5,20]],"date-time":"2020-05-20T00:00:00Z","timestamp":1589932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,5,20]],"date-time":"2020-05-20T00:00:00Z","timestamp":1589932800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,5,20]],"date-time":"2020-05-20T00:00:00Z","timestamp":1589932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Necrotizing fasciitis (NF) is a devastating disease with substantial morbidity and mortality. Poor outcomes are attributed to delayed diagnosis and management. Tenwek Hospital, a teaching and referral center in rural Kenya, manages many cases despite variable resources. We aimed to understand the burden of NF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients with admission NF diagnosis who presented in 2017 were reviewed for demographics, investigations, treatment, and outcomes. The primary outcome was unfavorable outcome defined as in\u2010hospital mortality or amputation. Secondary outcomes were discharge diagnosis of NF and cost. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated. Logistic regression models were utilized to assess the impact of risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010seven patients were identified with an average age of 49.2 (\u00b121) years. Medical comorbidities were present in 48% and history of trauma in 58%. Discharge diagnosis of NF occurred in 61% (<jats:italic>N<\/jats:italic>\u2009=\u200941). Overall, mortality occurred in 10% (<jats:italic>N<\/jats:italic>\u2009=\u20097) of patients with an initial NF diagnosis. At discharge, patients without NF had favorable outcomes in 96% (<jats:italic>N<\/jats:italic>\u2009=\u200925) compared to 78% (<jats:italic>N<\/jats:italic>\u2009=\u200932) with NF (<jats:italic>p<\/jats:italic>\u2009=\u20090.043). Final NF diagnosis costs 122,098\u00a0Kenyan Shillings more (95% confidence interval 36,142\u2013208,054) than non\u2010NF diagnosis (<jats:italic>p<\/jats:italic> value\u2009=\u20090.006). Factors associated with unfavorable outcome include diabetes mellitus, any comorbidity, increased heart rate, fever, hyperglycemia, anemia, and discharge NF diagnosis. Increased LRINEC score was associated with discharge NF diagnosis (<jats:italic>p<\/jats:italic>\u2009=\u20090.0006) and unfavorable outcome (<jats:italic>p<\/jats:italic>\u2009=\u20090.0157).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with NF in rural Kenya experience delays to presentation, unfavorable outcomes, and substantial costs. Certain factors, including LRINEC score, help predict diagnosis and outcome.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05581-4","type":"journal-article","created":{"date-parts":[[2020,5,20]],"date-time":"2020-05-20T16:52:18Z","timestamp":1589993538000},"page":"2919-2926","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Necrotizing Fasciitis: A Predictable Burden in Rural Kenya"],"prefix":"10.1002","volume":"44","author":[{"given":"Joyce","family":"Lunar","sequence":"first","affiliation":[{"name":"Department of Surgery Tenwek Hospital P.O. Box 39 20400 Bomet Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinkeet S.","family":"Ranketi","sequence":"additional","affiliation":[{"name":"Department of Surgery Tenwek Hospital P.O. Box 39 20400 Bomet Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly","family":"Owino","sequence":"additional","affiliation":[{"name":"Department of Surgery Tenwek Hospital P.O. Box 39 20400 Bomet Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Oloo","sequence":"additional","affiliation":[{"name":"Department of Surgery Tenwek Hospital P.O. Box 39 20400 Bomet Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4794-5821","authenticated-orcid":false,"given":"Robert K.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Surgery Tenwek Hospital P.O. Box 39 20400 Bomet Kenya"},{"name":"Department of Surgery Alpert Medical School of Brown University Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1600673"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.qco.0000160896.74492.ea"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749\u20107922\u20109\u201057"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2010.01.028"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749\u20107922\u20102\u201019"},{"key":"e_1_2_9_7_1","first-page":"304","article-title":"Implications of risk factors in necrotizing fasciitis","volume":"59","author":"Francis K","year":"1993","journal-title":"Am 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May 2020","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 datasets during and\/or analyzed during the current study are available from the corresponding author on reasonable request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of data and materials"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The study was approved by the Institutional Ethical Review Committee of Tenwek Hospital.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}