{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:26:48Z","timestamp":1788348408373,"version":"build-2803163510"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patients with extensive and complex wounds due to Necrotizing Soft-Tissue Infections (NSTI) may be referred to a burn center. This study describes the characteristics, outcomes, as well as diagnostic challenges of these patients. Patients admitted to three hospitals with a burn center for the treatment of NSTI in a 5-year period were included. Eighty patients (median age 54 years, 60% male) were identified, of whom 30 (38%) were referred by other centers, usually after survival of the initial septic phase. Those referred from other centers, compared to those primarily admitted to the study hospitals, were more likely to have group A streptococcal involvement (62% vs 35%, p = .02), larger wounds (median 7% vs 2% total body surface area, p &amp;lt; .001), and a longer length of stay (median 49 vs 22 days, p &amp;lt; .001). Despite a high incidence of septic shock (50%), the mortality rate was low (12%) for those primarily admitted. Approximately half (53%) of the patients were initially misdiagnosed upon presentation, which was associated with delay to first surgery (16 hours vs 4 hours, p &amp;lt; .001). Those initially misdiagnosed had more (severe) comorbidities, and less frequently reported pain or blue livid discoloration of the skin. This study underlines the burn centers\u2019 function as referral centers for extensively affected patients with NSTI. Besides the unique wound and reconstructive expertise, the low mortality rate indicates these centers provide adequate acute care as well. A major remaining challenge remains recognition of the disease upon presentation. Future studies in which factors associated with misdiagnosis are explored are needed.<\/jats:p>","DOI":"10.1093\/jbcr\/irad073","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T15:21:18Z","timestamp":1685028078000},"page":"1405-1412","source":"Crossref","is-referenced-by-count":7,"title":["The Role of Burn Centers in the Treatment of Necrotizing Soft-Tissue Infections: A Nationwide Dutch Study"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7379-3900","authenticated-orcid":false,"given":"Jaco","family":"Suijker","sequence":"first","affiliation":[{"name":"Burn Centre, Red Cross Hospital , Beverwijk , The Netherlands"},{"name":"Association of Dutch Burn Centres , Beverwijk , The Netherlands"},{"name":"Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery , De Boelelaan 1117, Amsterdam , The Netherlands"},{"name":"Amsterdam Movement Sciences, Tissue Function and Regeneration , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1399-3801","authenticated-orcid":false,"given":"Lisca","family":"Wurfbain","sequence":"additional","affiliation":[{"name":"Burn Centre, Red Cross Hospital , Beverwijk , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk M L H","family":"Emmen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Rode Kruis Ziekenhuis , Beverwijk , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3594-4621","authenticated-orcid":false,"given":"Anouk","family":"Pijpe","sequence":"additional","affiliation":[{"name":"Burn Centre, Red Cross Hospital , Beverwijk , The Netherlands"},{"name":"Association of Dutch Burn Centres , Beverwijk , The Netherlands"},{"name":"Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery , De Boelelaan 1117, Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8560-5508","authenticated-orcid":false,"given":"Kelly A A","family":"Kwa","sequence":"additional","affiliation":[{"name":"Burn Centre, Red Cross Hospital , Beverwijk , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis H","family":"van der Vlies","sequence":"additional","affiliation":[{"name":"Burn Centre, Maasstad Ziekenhuis , Rotterdam , The Netherlands"},{"name":"Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5632-3333","authenticated-orcid":false,"given":"Marianne K","family":"Nieuwenhuis","sequence":"additional","affiliation":[{"name":"Association of Dutch Burn Centers, Burn Centre, Martini Hospital , Groningen , The Netherlands"},{"name":"Centre for Human Movement Sciences, University Medical Centre Groningen , Groningen , The Netherlands"},{"name":"Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen , Groningen , Nederland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3461-8848","authenticated-orcid":false,"given":"Paul P M","family":"van Zuijlen","sequence":"additional","affiliation":[{"name":"Burn Centre, Red Cross Hospital , Beverwijk , The Netherlands"},{"name":"Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery , De Boelelaan 1117, Amsterdam , The Netherlands"},{"name":"Amsterdam Movement Sciences, Tissue Function and Regeneration , Amsterdam , The Netherlands"},{"name":"Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre , Emma Children's Hospital, Meibergdreef 9, Amsterdam , Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annebeth","family":"Meij-de Vries","sequence":"additional","affiliation":[{"name":"Burn Centre, Red Cross Hospital , Beverwijk , The Netherlands"},{"name":"Department of Surgery, Rode Kruis Ziekenhuis , Beverwijk , The Netherlands"},{"name":"Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre , Emma Children's Hospital, Meibergdreef 9, Amsterdam , Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,25]]},"reference":[{"key":"2023110708064944500_CIT0001","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1056\/NEJMra1600673","article-title":"Necrotizing soft-tissue infections","volume":"377","author":"Stevens","year":"2017","journal-title":"N Engl J Med"},{"key":"2023110708064944500_CIT0002","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s00134-019-05730-x","article-title":"Patient\u2019s 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