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Surgical outcomes in adults with purpura fulminans:a systematic review and patientlevel meta-synthesis

Burns & Trauma 2019年第1期7卷 279-289页

作者： Kevin M.Klifto Caresse F.Gurno michael j.grzelak StellaM.Seal Mohammed Asif C.Scott Hultman julie A.Caffrey Department of Plastic and Reconstructive Surgery The Johns Hopkins University School of MedicineBaltimoreMDUSA The johns Hopkins University School of Nursing BaltimoreMDUSA Welch Medical Library The Johns Hopkins University School of MedicineBaltimoreMDUSA johns Hopkins Burn Center 4940 Eastern AvenueBaltimoreMD 21224USA

Background:Cutaneous manifestations of purpura fulminans(PF)present many challenges for clinicians and *** a state of septic shock complicated by limb ischemia,surgical interventions are necessary to control the pathological cascade and improve patient *** objective of this article was to report etiologies and surgical outcomes associated with cutaneous manifestations in ***:This systematic review and meta-analysis compared 190 adult patients with etiologies,signs and symptoms,and surgical outcomes associated with cutaneous manifestations of *** PubMed,EMBASE,Cochrane Library,Web of Science,and Scopus databases were systematically and independently *** and clinical characteristics,surgical interventions,outcomes,and complications were ***:Seventy-nine studies were eligible for the systematic review,and 77 were eligible for meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)and Cochrane guidelines.A total of 71/190(38%)cases reported surgical *** were reported in 12/190(6%)cases and 20 *** were reported in 154/190(81%)*** was reported in 45 *** grafts were applied in 31 *** were used for reconstruction in 28 ***(IQR)surgical procedures per patient were 4(4,5)*** organisms causing PF were 32%Neisseria meningitidis(n=55)and 32%Streptococcus pneumonia(n=55).Coagulase-negative Staphylococcus(95%confidence interval(CI)(8.2–177.9),p=0.032),Haemophilus influenza(95%CI(7.2–133),p=0.029),Streptococcus pneumonia(95%CI(13.3–75.9),p=0.006),and West Nile Virus(95%CI(8.2–177.9),p=0.032)were associated with significantly more extensive amputations compared to other ***:This systematic review and patient-level meta-analysis found the most common presentation of PF was septic shock from an infectious *** meningitidis and Streptococcus pneumonia were equally

关键词： Amputation Burn units Neisseria Purpura fulminans Reconstructive surgical procedures Shock Septic Surgeons Treatment outcome

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