Purpose
Acute infections of the distal upper extremity (UE) can require one and possibly multiple
debridements. We aimed to develop and validate a prognostic scoring system based on
patient, infection, and microbiology risk factors to help with operative planning
and patient counseling.
Methods
We studied all acute surgical UE infections distal to the elbow joint over a 5-year
period. A split-sample design was created with 1:1 randomization into development
and validation samples. The primary outcome was infection persistence, defined as
the need for additional operative drainage according to usual indications. Multivariable
logistic regression identified risk factors for persistent infections in the development
sample, which was translated to a simple clinical scoring system derived from regression
coefficients. The model was then tested separately against the validation sample.
Results
A total of 602 patients were included; 31% of all infections exhibited persistence.
Independent risk factors from the development sample included diabetes (3 points),
smoking (2 points), leukocytosis at presentation (2 points), animal bite mechanism
(3 points), osteomyelitis (4 points), tenosynovitis (7 points), pyarthrosis (3 points),
necrotizing fasciitis (11 points), and methicillin-resistant Staphylococcus aureus (3 points). These were all confirmed in the validation sample. Infections were categorized
into 3 groups based on risk for persistent infection: low (less than 8 points), medium
(8–11 points), and high (12 points or more). In the validation sample, the probability
of persistent infection for these 3 groups was 23%, 57%, and 79%, respectively. The
c statistic for the model in the validation sample was 0.79.
Conclusions
Persistence of acute surgical distal UE infections is mediated by patient and microbiology
factors, as well as infection mechanism and type. Surgeons can use this risk-adjusted
prognostic scoring system to anticipate which infections may require additional therapeutic
debridement and plan operative schedules and counsel patients accordingly.
Type of study/level of evidence
Prognostic II.
Key words
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Article info
Publication history
Accepted:
October 11,
2019
Received:
August 22,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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