Background:
Pre-operative white blood cell (WBC) and C-reactive protein (CRP) frequently contribute to clinical decision making in patients with upper limb infections. Their utility in indicating which patients require surgical debridement is not fully understood. A study by Gauger et al. found that among patients who underwent surgical debridment and had positive intra-operative cultures, CRP and WBC were raised in 90% and 54 % of patients respectively.
Methods:
Data were collected retrospectively from discharge summaries over a 5 year period (2018 to 2022). Patients were included if they were aged over 18, underwent surgical debridement of an upper limb infection, had positive intra-operative cultures and had pre-operative CRP and WBC measured.
Results:
One hundred and fifty four patients were included. Male patients and smokers were disproportionately represented within the study population (66.2% and 30.5% respectively). Despite using lower normal laboratory thresholds than the original study, we found lower values for both CRP and WBC (raised in 76.6% and 35.1% of patients respectively). The median number of debridements was 2. The median length of hospital stay was 2 days. The most common site of infection was the lesser fingers. The most common organism on culture was Staphylococcus aureus.
Conclusion
Pre-operative inflammatory markers are limited in their contribution to clinical decision making in this setting. WBC and CRP may be normal despite patients having infections that require surgical debridement. CRP appears to be more sensitive in than WBC.