SnapNSTI is an international, multicenter, time-bound prospective observational cohort study designed to characterize current epidemiology, management patterns, and outcomes of patients with necrotizing soft-tissue infections (NSTI). The primary objective is to estimate 90-day all-cause mortality and to evaluate the variability in management across centers. The study will also explore the association between clinical characteristics, treatments, and patient-reported outcomes.
Necrotizing soft-tissue infections (NSTIs) are life-threatening surgical emergencies with high mortality despite timely surgical debridement and antibiotic treatment. Wide variability in treatment strategies-ranging from diagnostic imaging to operative timing and adjunctive therapies-contributes to outcome heterogeneity, yet no standardized, high-resolution prospective data exist to guide best practices. SnapNSTI is a time-bound, multicenter international observational cohort study coordinated by the Center for Emergency Surgery Outcomes Research (CESOR) at the University of Pennsylvania, and led by a consortium of international surgical societies. The study will enroll adult patients with confirmed NSTI over a 6-month window at each participating site within a 12-month period starting in 2026. The primary outcome is 90-day all-cause mortality. Secondary outcomes include organ support-free days, in-hospital complications, length of stay, and 60-day patient-reported outcomes (PROMs, including the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument). Standardized definitions and real-time REDCap-based data collection will ensure data quality. Analyses will include multivariable regression, propensity score methods, and target trial emulation. Results will inform future interventional research and evidence-based guidelines.
Study Type
OBSERVATIONAL
Enrollment
480
Hospital del Mar
Barcelona, Spain
90-day all-cause mortality
All-cause mortality measured at 90 days from hospital admission in patients with confirmed necrotizing soft-tissue infection (NSTI). Mortality status will be obtained via chart review, clinical follow-up or telephone contact.
Time frame: 90 days from admission
Organ failure-free days within first 30 days
Number of days alive and free from mechanical ventilation, vasopressors, or renal replacement therapy within 28 days from admission.
Time frame: 30 days from admission
Hospital and ICU length of stay
Number of days from hospital admission to discharge in ICU, including both days. Reported in days, as a continuous variable.
Time frame: From admision to ICU to discharge to the ward or death
Number and type of reoperations
Number and type of surgical re-interventions performed after the initial debridement, including amputations, repeat debridement, and drainage procedures.
Time frame: From admission to 90 days
Patient-reported quality of life (EQ-5D-5L)
Self-reported health status at 60 days after admission using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument. This includes five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain is scored on a 5-point scale (1 = no problems; 5 = extreme problems). The score varies from 5 to 25 points.
Time frame: 60 days from admission
Readmission and return to surgery within 90 days
Incidence and reasons for hospital readmissions or return to operating room within 90 days from index admission.
Time frame: 90 days from admission
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