Children with Deep Space Neck Infections: Our Experience with 178 Children and Proposed Management Strategy

Abstract

Objectives: Identify clinical features associated with unsuccessful medical therapy in children with deep space neck infections (DSNI). Propose a clinical decision-making algorithm, which may avoid radiation exposure from computed tomography (CT) imaging, based on clinical features found to be associated with surgical intervention for DSNI and those at highest risk for complicated clinical courses. Methods: Consecutive case series with chart review at a tertiary-care, academic children’s hospital. One hundred and seventy-eight pediatric patients treated for retropharyngeal or parapharyngeal infections between July 1, 2007, and May 23, 2012. Results: Median age was 34.5 months (2.9 years, range 2 to 142 months); two-thirds were male. Increased surgical drainage was found in children age ≤ 15 months ( P = 0.002) and for abscesses greater than 2.2 cm ( P = 0.0001). Risk factors associated with increased likelihood of medical therapy failure included ≤ 51 months, ICU admission, and CT findings consistent with abscess size greater than 2.2 cm. Methicillin-resistant Staphylococcus aureus infections were found more often in younger children, with the highest incidence in those ≤ 15 months of age ( P = 0.001). All children had resolution of infection. Conclusions: Deep space neck infections in children can often be successfully managed with medical therapy alone, but life-threatening complications may occur. We recommend that young patients be managed cautiously. A proposed decision making algorithm is presented, but caution and careful clinical judgment need to be exercised as further prospective study is warranted.