Abstract

Necrotizing fasciitis is a soft tissue infection in which early recognition and limb-saving surgery are critical, and the diagnosis in the emergency department (ED) is often delayed. In this systematic review, strategies for early identification and timing of limb-saving interventions were evaluated in patients with necrotizing fasciitis. PRISMA guidelines were followed, and electronic databases were searched for original studies conducted in emergency settings. Eligible studies reported clinical, laboratory, imaging, or biopsy-based approaches to early diagnosis and described the outcomes of limb-saving procedures. Data were qualitatively synthesized. Ten studies were included; the largest enrolled 1,506 surgically confirmed cases. Improved survival and limb preservation were found to be associated with high clinical suspicion, early risk stratification, and rapid access to debridement. Laboratory scores, LRINEC, were more useful for prediction than for ruling out disease. Pointof-care ultrasound and biopsy facilitated earlier operative decisions when presentation was ambiguous. The integration of clinical red flags, simple laboratory indices, bedside imaging, and structured risk scores shortens diagnostic delay in the ED and improves outcomes in necrotizing fasciitis.

Key words: Necrotizing fasciitis, emergency department, early diagnosis, amputation, LRINEC score, systematic review.