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Invited Critique
May 2010

Computed Tomography to Exclude Necrotizing Soft Tissue Infection: Not Quite Ready for Prime Time?Comment on “Diagnosis of Necrotizing Soft Tissue Infections by Computed Tomography”

Author Affiliations

Author Affiliation: Yale University School of Medicine, New Haven, Connecticut.

Arch Surg. 2010;145(5):455. doi:10.1001/archsurg.2010.52

Dr Zacharias and colleagues have proposed that a negative CT result can reliably exclude the presence of NSTI, providing that a 16- or 64-section helical CT is used and intravenous contrast given. Although they report no false-negative CT results, 1 scan in a patient with a surgically confirmed NSTI was “equivocal” and CT needed to be repeated within 12 hours. Such an event might be considered a false-negative result in the purest sense and therefore could have altered the reported results. Although it has been described that repeat CT imaging may have a role in the diagnosis of NSTI in select patients, the need for an additional contrast load in the face of infection and end-organ dysfunction needs to be carefully weighed against any potential benefits.

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