Increased incidence of head and neck abscesses in children

Abstract

Objectives: Describe the changing incidence, microbiology and management of head and neck abscesses in children admitted during the first quarters of 2000–2003. Methods: Retrospective chart and data warehouse review in a tertiary care pediatric hospital. A broad range of ICD-9 codes were used to identify 965 potentially appropriate patient encounters in children <19 years admitted during the first quarters of 2000–2003 with possible head and neck abscesses, excluding mastoiditis. Data review confirmed 89 relevant infections. Outcome measures included incidence of infections relative to total hospital admissions evaluated by chi-square technique and evaluation of abscess location, management, and microbiology. Results: Forty-two of 2310 hospital admissions (1.8%) during the first quarter of 2003 were compared to 13 of 1791 (0.7%), 18 of 2141 (0.8%), and 16 of 2192 admissions (0.7%) in 2000, 2001, and 2002, respectively ( P < 0.004). 38 peritonsillar, retropharyngeal or parapharyngeal infections; 26 neck infections; 13 orbital or intracranial complications of acute sinusitis; and 12 facial infections were identified. Sixty-six (74%) were managed surgically, 2 additional ones were drained by needle aspiration. Various streptococcal species were identified in 28 cultures, staphylococcus in 6, atypical mycobacterium in 3, and other organisms in 20; cultures from some patients revealed multiple organisms. Conclusions: The incidence and proportion of head and neck infections in children admitted to the study hospital increased significantly during the first quarter of 2003. The most common organism identified was group A streptococcus. This is in agreement with reports from other institutions of an increasing incidence of streptococcal infections.