Early surgical intervention enhances recovery of severe pediatric deep neck infection patients. (May 2021)

• Record Type: Journal Article
• Authors: Velhonoja, Jarno; Lääveri, Meira; Soukka, Tero; Hirvonen, Jussi; Kinnunen, Ilpo; Irjala, Heikki
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 144(2021)
• Publication Date: 2021-05
• Subjects: Pediatric -- Deep neck space -- Infection -- Abscess; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2021.110694
• Languages: English
• ISSNs: 0165-5876

Abstract

Abstract: Purpose: Pediatric deep neck space infection (DNI) is a relatively rare but potentially life-threatening condition and requires prompt and accurate management. This study retrospectively reviews our experience in a tertiary referral hospital from 2004 to 2019. Methods: Systematic data collection from medical records using ICD10 codes between 2004 and 2019. Inclusion criteria: age ≤16 years, DNI requiring hospitalization and/or surgery. Exclusion: peritonsillar abscess without complications. Results: We identified 42 patients, 21 boys and 21 girls, with a median age of 4.9 years. Most of the patients had severe symptoms, the most common of which were neck swelling (n = 39; 92.9%), neck pain (n = 39; 92.9%) and fever (n = 32; 76.2%). Twenty-two (52.4%) had torticollis, and the mean duration of symptoms before hospitalization was 4.95 days. Diagnosis was confirmed by MRI (n = 24), contrast-enhanced CT (n = 11) or ultrasonography (n = 6), except in one case. Twenty-three (54.8%) required an open neck incision, ten (23.8%) patients had intraoral surgery and nine were treated conservatively. Twelve (28.6%) patients were admitted to the pediatric ICU. Median hospitalization duration was six days. The infection most commonly had tonsillopharyngeal etiology (n = 18) and a retropharyngeal location (n = 17). Staphylococcus Aureus (n = 7) and Streptococcus pyogenes (n = 7) were the most frequent pathogens. We compared the early surgical intervention group (<2 days of intravenous antibiotics; n = 18; 42.9%) to the late surgery group (n = 15; 35.7%) and the conservatively treated groups (n = 9; 21.4%). The overall length of stay (LOS) was lower in the shorter preoperative medication group (mean 4.4 vs. 7.2; p = 0.009). The size of the abscess did not differ between the groups (mean 28 mm; 30 mm; 21 mm; p = 0.075) and the neck incision rate was similar in the operated groups. Conclusion: Early surgical intervention is associated with decreased LOS among severe pediatric DNI patients.