430 Most Pediatric Patients With Retropharyngeal Abscess Are Afebrile

Abstract

Retropharyngeal abscesses (RPA) are uncommon, diagnostically challenging, and results in significant morbidity and mortality if untreated. Fever is often used as 1 of the screening tool in the diagnostic workup of RPA. To evaluate the prevalence of fever in patients diagnosed with RPA. Design: Retrospective cohort study. Participants: All patients presenting to the ED between Dec 2003 and May 2008 in 21 New Jersey and New York hospitals. ICD9 final diagnosis of RPA was extracted using EMARS database. A manual chart review was conducted on all pediatric patients (<21yrs) with the ICD9 final diagnosis of RPA. Data extraction was performed by study physician who were blinded to the final study outcomes. Fever (defined as > 38°C) and inflammatory makers (WBC, bandemia, Erythrocyte Sedimentation Rate and C reactive Protein) were analyzed. Patients were excluded if an alternative diagnosis was determined, temperature was not documented, or chart unavailability. Statistics: Wilcox Mann-Whitney Test with a preset alpha of < 0.05. Eighty-three charts were evaluated with the diagnosis of RPA. Nineteen were excluded based on above criteria, leaving 64. The median age was 6.43 years (IQR: 3.08-7.33). Females comprised 45%. Admission occurred in 94%, with 11% requiring transfer for this. Mean temperature was 37.8 (95% CI 37.5 to 38.0) with 37 patients (58%) being afebrile. Twenty-nine patients had prior antipyretic usage with a mean temperature of 37.7 versus those who did not 37.9 (p=0.50). Thirty-seven patients had a prior physician encounter. Previous antibiotic usage occurred in 42.6%. Mean WBC count was 17.5 k/cmm with 31.5%(n=17) found to be normal (6-14 k/cmm). Bands were present in 28 patients, though abnormal (> 10%) in only 8. Mean bandemia was 6.9%. ESR was evaluated in 12 patients with a mean value of 72.6mm/hr, none were normal (<10). CRP was evaluated in 11 patients with a mean level of 62.73 mg/L. A normal CRP (<9mg/L) was seen in 30%. Comparing patients <4 years (preverbal) to those patients >4 years, the mean temperatures were: 37.9 and 37.8 (p=0.66), respectively. Most pediatric patients with retropharyngeal abscesses are afebrile.