Journal article
Understanding the Prodrome of Necrotizing Soft Tissue Infections of the Genitalia (Fournier's Gangrene) and the Incidence, Duration, and Risk Factors Associated with Potential Missed Opportunities for an Earlier Diagnosis: A Population-Based Longitudinal Study
The journal of urology, Vol.208(6), pp.1259-1267
08/25/2022
DOI: 10.1097/JU.0000000000002920
PMCID: PMC11005462
PMID: 36006046
Abstract
PURPOSETo investigate patterns of healthcare utilization leading up to diagnosis of necrotizing soft tissue infections of the genitalia (NSTIG) and to identify risk factors associated with potential diagnostic delay. MATERIALS AND METHODSThe Truven Health Analytics Commercial Claims Databases (2001-2020) was used to identify index cases of NSTIG. We identified healthcare visits for symptomatically-similar diagnoses (SSD; e.g. penile swelling, cellulitis) that occurred prior to NSTIG diagnosis. A change-point analysis identified the window before diagnosis where diagnostic opportunities first appeared. A simulation model estimated the likelihood SSD visits represented a missed opportunity for earlier diagnosis. Patient and provider characteristics were evaluated for their associations with delay. RESULTSWe identified 8,098 patients with NSTIG, in which 4032 (50%) had an SSD visit in the 21-day diagnostic window, most commonly for "non-infectious urologic abnormalities" (e.g. genital swelling; 64%): 46% received antibiotics; 16% saw a Urologist. Models estimated that 5096 of the SSD visits (63%) represented diagnostic delay (mean duration 6.2 days; mean missed opportunities 1.8). Risk factors for delay included urinary tract infection history (OR 2.1) and morbid obesity (OR 1.6). Visits to more than one healthcare provider/location in a 24-hour period significantly decreased delay risk. CONCLUSIONSNearly 50% of insured patients that undergo debridement for, or die from, NSTIG will present to a medical provider with an SSD suggestive of early disease development. Many of these visits likely represent diagnostic delay. Efforts to minimize logistic and cognitive biases in this rare condition may lead to improved outcomes if they lead to earlier interventions.
Details
- Title: Subtitle
- Understanding the Prodrome of Necrotizing Soft Tissue Infections of the Genitalia (Fournier's Gangrene) and the Incidence, Duration, and Risk Factors Associated with Potential Missed Opportunities for an Earlier Diagnosis: A Population-Based Longitudinal Study
- Creators
- Bradley A Erickson - Roy J. and Lucille A. Carver College of MedicineAaron C Miller - Roy J. and Lucille A. Carver College of MedicineHayden L Warner - Roy J. and Lucille A. Carver College of MedicineJustin N Drobish - Roy J. and Lucille A. Carver College of MedicineScott H Koeneman - University of IowaJoseph E Cavanaugh - University of IowaPhillip M Polgreen - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- The journal of urology, Vol.208(6), pp.1259-1267
- DOI
- 10.1097/JU.0000000000002920
- PMID
- 36006046
- PMCID
- PMC11005462
- NLM abbreviation
- J Urol
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Language
- English
- Date published
- 08/25/2022
- Academic Unit
- Statistics and Actuarial Science; Infectious Diseases; Epidemiology; Biostatistics; Injury Prevention Research Center; Urology; Internal Medicine
- Record Identifier
- 9984296998502771
Metrics
25 Record Views