CESORCenter for Emergency Surgery Outcomes Research
SnapNSTI
Prospective international study of necrotizing soft tissue infection.
SnapNSTI is an international, time-bound prospective observational cohort study that characterizes the epidemiology, debridement timing, antimicrobial management, adjunctive therapy use, and 90-day outcomes of necrotizing soft tissue infection under real-world acute care conditions. The platform produces decision-facing observational evidence while preserving the temporal structure required for design-first causal analyses of operative timing and related management pathways.
Leadership and governance
Gary Alan Bass, MD, MSc, MBA, PhD, FICS, FEBS (Emergency Surgery)
Assistant Professor of Surgery and Assistant Professor of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
gary.bass@pennmedicine.upenn.edu
Ana María González Castillo, MD, PhD, FEBS (Emergency Surgery)
Hospital del Mar, Barcelona
amgonzalezcastillo@gmail.com
SnapNSTI is coordinated through CESOR with scientific oversight from an international steering structure that includes representatives from ESTES, ASGBI, SIS-NA, and SIS-E alongside senior surgical and methodological collaborators.
Primary and subsidiary manuscripts follow an ICMJE-aligned, contribution-based framework with CRediT role reporting, manuscript-specific writing committees, and structured steering review for secondary analyses.
Why this study exists
Necrotizing soft tissue infection remains one of the highest-acuity emergencies in surgery. Mortality stays substantial despite advances in critical care, broad-spectrum antimicrobial therapy, and aggressive operative source control. Yet prospective multicenter data on how patients are diagnosed, triaged, debrided, supported, and followed are still thin.
SnapNSTI addresses that gap. It captures management with admission-relative timing, explicit documentation of treatment pathways, and standardized definitions across centers so the field can distinguish descriptive variation from questions mature enough for causal analysis.
Primary outcome
90-day mortalityAll-cause mortality through 90 days after admission
Secondary outcomes
Organ failure-free daysPlus complications, reintervention, LOS, and short-term recovery
Time zero
Hospital admissionAll major temporal variables are captured relative to admission
Scale
50 international centersTargeting roughly 480 participants across Europe and North America
Design
International multicenter enrollment of consecutive adult NSTI cases using standardized snapshot methodology and routinely collected clinical data only.
Key events are recorded as intervals from hospital admission to preserve temporal ordering for analyses of debridement timing, antimicrobial concordance, and downstream outcomes.
The platform captures diagnostic pathway, timing to source control, microbiology, empiric and culture-concordant therapy, repeat debridement, organ support, and complications.
Structured fields cover adjunctive therapies such as IVIG, hyperbaric oxygen, NPWT, fluorescence-assisted imaging, and 90-day recovery including optional PROMs where locally approved.
Prespecified analytic program
M1
M2
M3
Spin-off work
Design discipline matters here. SnapNSTI is not a registry-shaped dataset. Its value depends on preserving the timing, feasibility, and pathway detail required to separate descriptive benchmarking from clinically interpretable analysis.
The platform therefore pairs broad international case capture with structured data quality control, prespecified analytic domains, and explicit governance over data use, authorship, and subsidiary analyses.
For participating centers and collaborators
SnapNSTI is for centers able to support consecutive prospective case ascertainment, structured data entry, local governance approval, and 90-day follow-up using routine clinical data. Methodologic collaborators, infectious disease experts, analysts, and implementation scientists are considered through CESOR participation pathways.
For participating centers
Centers interested in participation should contact the study leadership and submit structured intake through CESOR.
For analysts and collaborators
Collaborators with relevant statistical, microbiologic, critical care, implementation, or emergency surgery expertise should review CESOR participation pathways before outreach.
Publication structure
The prespecified manuscript program spans timing and systems, microbiology and antimicrobial strategy, and adjunctive therapy utilization, with additional spin-off work in phenotyping and risk stratification where the data justify it.