Severe necrotizing soft tissue infections (SENSEI) study: Protocol for a multi-centered audit

Sep 29, 2026

Severe necrotizing soft tissue infections are surgical emergencies often accompanied by sepsis, with high mortality and major long-term psychosocial effects for patients and families. Early recognition and timely surgical management with broad-spectrum antibiotics are essential, yet diagnosis is frequently delayed or misattributed to conditions like cellulitis or abscess. The SENSEI study protocol describes a UK-wide multi-centered retrospective audit to assess current practice for adult and paediatric populations against Surviving Sepsis Campaign and Sepsis 6 standards.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Study aims

Materials, patients and methods

Audit design and data collection

Ethics & dissemination

JPRAS Open 48 (2026) 331–336 Contents lists available at ScienceDirect JPRAS Open journal [homepage:](homepage: www.elsevier.com/locate/jpra)[ www.elsevier.com/locate/jpra](homepage: www.elsevier.com/locate/jpra) Original Article Severe necrotizing soft tissue infections (SENSEI) study: Protocol for a multi-centered audit R. Yoshimura a, 1,∗, T. Hughes b, 1, M. Carter b, C. Sethub, J.C.R. Wormaldc a York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK b Oxford University Hospitals NHS Foundation Trust, Oxford, UK c Nuﬃeld Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK a r t i c l e i n f o Article history: Received 16 July 2025 Accepted 9 November 2025 Available online 15 November 2025 Keywords: Severe necrotizing soft tissue infections Sepsis Necrotizing fasciitis Fournier’s gangrene ∗ Corresponding author. a b s t r a c t Background: Severe soft tissue infections are surgical emergencies typically accompanied by sepsis. Early recognition and management optimizes patient outcomes. Single-centered studies on these infections are limited due to their rare incidence. Materials & methods: We propose a protocol for the SENSEI (Severe Necrotizing Soft Tissue Infections) study, a multi-centered audit across the United Kingdom to assess current clinical practice for treating severe soft tissue infections in adult and paediatric populations. This will be compared with standards predetermined by the Surviving Sepsis Campaign and Sepsis 6. This audit will follow a trainee collaborative model, where doctors in surgery and ICU are invited to participate by the Reconstructive Surgery Trials Network and Paediatric Critical Care Society Audit Network. Each site will have a local lead, and at least one collaborator each from surgical and intensive care teams. Data collected will include presentation, investigations, and management of severe soft tissue infections. Ethics & dissemination: As the SENSEI study is an audit and not research, approval is not required from a NHS research ethics com- E-mail address: [ryo.yoshimura1@nhs.net](ryo.yoshimura1@nhs.net) (R. Yoshimura) . 1 These authors contributed equally to this protocol, as joint ﬁrst authors. [https://doi.org/10.1016/j.jpra.2025.11.016](https://doi.org/10.1016/j.jpra.2025.11.016) 2352-5878/© 2025 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)) R. Yoshimura, T. Hughes, M. Carter et al. JPRAS Open 48 (2026) 331–336 mittee. Findings of the study will be reported in scientiﬁc meetingsand peer-reviewed journals. © 2025 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)) Introduction Severe necrotizing soft tissue infections (SSTIs) are a group of life-threatening infections, with reported mortality rates as high as 40 %.1 There are estimated to be 500 new cases every year with 0.4 to 0.53 cases per 100,000 population.2 , 3 They are surgical emergencies, characterized by rapidly progressive necrosis of subcutaneous tissue, fascia or muscle, accompanied by sepsis. In addition to mortality, SSTIs can have a long-term psychosocial impact on both patients and their families.4 Prompt surgical management and broad-spectrum antibiotics are essential for treating SSTIs. Surgery involves complete debridement of infected and necrotic tissue to limit the spread of the infection.5 , 6 In extensive upper and lower limb infections, this may involve amputation. Early debridement leads to reduced mortality, fewer number of surgical debride

FAQs

What clinical problem does the SENSEI study address?

The study focuses on severe necrotizing soft tissue infections, which are life-threatening surgical emergencies often associated with sepsis and rapid progression of necrosis.

How will the SENSEI study evaluate current treatment practice?

It will conduct a multi-centered audit across the UK, comparing current clinical practice with predetermined standards from the Surviving Sepsis Campaign and Sepsis 6 guidelines.

What data will be collected during the audit?

Data collected will include presentation, investigations, and management of severe necrotizing soft tissue infections across participating sites.

Sep 29, 2026

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