Necrotizing soft-tissue infections (NSTI) are often life-threatening illnesses that may be best treated at specialty care facilities such as burn centers. However, little is known about current treatment patterns nationwide. The purpose of this study was to describe the referral patterns for treatment of NSTI using a multistate discharge database and to investigate the differences in patients with NSTIs treated at burn centers and nonburn centers. The National Inpatient Sample is an all-payer inpatient database from 37 states containing data from 14 million hospital stays each year. We identified all patients with NSTI using International Classification of Disease version 9 codes for necrotizing fasciitis (728.86), gas gangrene (040.0), and Fournier’s gangrene (608.83) for the years 2001 and 2004. Patients were dichotomized by location of definitive treatment—either burn centers or nonburn centers. Burn center status was ascertained from the current American Burn Association burn center directory. Patient characteristics, payer status, hospital course, mortality rates, and disposition were compared between patients treated at burn centers and nonburn centers. In 2001 and 2004, a total of 10,940 patients were identified as having a NSTI. The majority (87.1%) of these patients received definitive care at nonburn centers. Patients treated at burn centers were more likely to be transferred from another hospital (OR 2.0, CI 1.8–2.2) and were more likely to have Medicaid (22.6% vs 16.3%, OR 1.39) or be uninsured (18.8% vs 13.7%, OR 1.38). Patients treated at burn centers had more surgical procedures (4.6 vs 4.3, P <.01), and higher hospital charges ($101,800 vs $68,500, P <.01). Total length of stay was also longer at burn centers (22.1 vs 16.0 days, P <.01). Based on a national discharge database, the majority of patients with NSTI are treated at nonburn centers. However, patients treated at burn centers were more likely to be transferred from non-burn centers, had longer lengths of stay, and underwent more operations, all of which are likely attributable to a greater severity of infection.
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机译：坏死性软组织感染（NSTI）通常是威胁生命的疾病，在烧伤中心等特殊护理机构中可能最好得到治疗。但是，对全国目前的治疗方式知之甚少。这项研究的目的是描述使用多州出院数据库治疗NSTI的转诊模式，并研究在烧伤中心和非烧伤中心治疗的NSTI患者的差异。国家住院样本是来自37个州的全额住院病人数据库，其中包含每年1400万住院次数的数据。我们使用“国际疾病分类”第9版代码对2001年和2004年的坏死性筋膜炎（728.86），气性坏疽（040.0）和Fournier坏疽（608.83）进行了识别。根据明确的治疗位置将患者分为两类：烧伤中心或非烧伤中心。可从当前的美国烧伤协会烧伤中心目录中确定烧伤中心的状态。比较了烧伤中心和非烧伤中心接受治疗的患者的患者特征，付款人状况，医院病程，死亡率和处置情况。在2001年和2004年，共有10,940名患者被确定患有NSTI。这些患者中的大多数（87.1％）在非烧伤中心接受了最终治疗。在烧伤中心接受治疗的患者更有可能从另一家医院转院（OR 2.0，CI 1.8–2.2），更有可能获得医疗补助（22.6％比16.3％，OR 1.39）或没有保险（18.8％比13.7％，或1.38）。在烧伤中心接受治疗的患者需要进行更多的外科手术（4.6比4.3，P <.01），以及更高的住院费用（101,800美元对68,500美元，P <.01）。烧伤中心的总住院时间也更长（22.1 vs 16.0天，P <.01）。根据国家出院数据库，大多数NSTI患者在非烧伤中心接受治疗。但是，在烧伤中心接受治疗的患者更有可能从非烧伤中心转移过来，住院时间更长，并且进行了更多的手术，所有这些都可能归因于感染的严重性更高。
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