Background

Neck-related chief complaints are common in the pediatric Emergency Department (ED), and although the incidence of pathology such as retropharyngeal abscesses is rare, the ability to rule out abscesses requiring surgical/procedural intervention is essential. However, there are no clear clinical guidelines regarding work-up and diagnosis in this population, possibly contributing to an excess use of potentially harmful and costly computed tomography (CT) imaging.

Objective

In this study we sought to identify historical, physical exam, and laboratory findings associated with surgically significant neck abscesses to better delineate CT neck imaging criteria.

Methods

We conducted a retrospective chart review of all patients ≤18 years presenting to a pediatric ED between 2013 and 2017 who underwent CT neck imaging. Surgically significant abscesses (SSAs) were defined as abscesses ≥2 cm, retropharyngeal abscesses (RPA), parapharyngeal abscesses (PPA), or peritonsillar abscesses (PTA). Historical factors, physical exam findings, laboratory results, demographics, and CT results were analyzed using univariate statistical analysis and regression models.

Results

A total of 718 patients received neck CTs and 153 SSAs were identified. In children younger than 6 years, factors associated with statistically significant increased odds of an SSA were reported throat pain (OR 1.18; 95% CI 1.05, 1.33), fussiness (OR 1.18; 1.01, 1.39), lethargy (OR 1.43; 1.07, 1.91), tonsillar enlargement (OR 1.17; 1.02, 1.34), C-reactive protein (CRP) > 10 (OR 1.22; 1.07, 1.40), and an ED visit within the preceding week (OR 1.18; 1.04, 1.33). In children older than 6 years, the factors associated with statistically significant increased odds of an SSA included current antibiotic use (OR 1.12; 1.02, 1.22) and a CRP >10 (OR 1.14; 1.03, 1.26).

Conclusion

Some historical, physical exam, and laboratory findings are associated with SSAs, and while not definitive in isolation, may be beneficial additions to routine SSA assessment, as a supplement to clinical judgement regarding CT and observation decisions. This may potentially allow for the identification of patients requiring CT versus those who may not, and thus the opportunity to safely reduce the use of CT imaging in select patients.

中文翻译：

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儿科患者颈部计算机断层扫描评估中与手术显着脓肿相关的特征

背景

颈部相关的主诉在儿科急诊科 (ED) 中很常见，虽然咽后脓肿等病理的发生率很少，但排除需要手术/程序干预的脓肿的能力至关重要。然而，没有关于该人群的检查和诊断的明确临床指南，这可能导致过度使用具有潜在危害和成本高昂的计算机断层扫描 (CT) 成像。

客观的

在这项研究中，我们试图确定与手术明显的颈部脓肿相关的病史、体格检查和实验室检查结果，以更好地描绘 CT 颈部成像标准。

方法

我们对 2013 年至 2017 年间就诊于儿科 ED 并接受 CT 颈部成像的所有≤18 岁患者进行了回顾性图表审查。手术显着脓肿 (SSAs) 定义为脓肿≥2 cm、咽后脓肿 (RPA)、咽旁脓肿 (PPA) 或扁桃体周围脓肿 (PTA)。使用单变量统计分析和回归模型分析历史因素、体检结果、实验室结果、人口统计学和 CT 结果。

结果

共有 718 名患者接受了颈部 CT，并确定了 153 名 SSA。在 6 岁以下儿童中，与 SSA 发生率显着增加相关的因素包括喉咙痛 (OR 1.18; 95% CI 1.05, 1.33)、烦躁 (OR 1.18; 1.01, 1.39)、嗜睡 (OR 1.43; 1.07, 1.91）、扁桃体增大（OR 1.17；1.02、1.34）、C反应蛋白（CRP）> 10（OR 1.22；1.07、1.40），以及前一周内的急诊就诊（OR 1.18；1.04、1.33）。在 6 岁以上的儿童中，与 SSA 几率显着增加相关的因素包括当前的抗生素使用（OR 1.12；1.02，1.22）和 CRP >10（OR 1.14；1.03，1.26）。

结论

一些病史、体格检查和实验室检查结果与 SSA 相关，虽然不能单独确定，但可能是对常规 SSA 评估的有益补充，作为对 CT 和观察决策的临床判断的补充。这可能允许识别需要 CT 的患者与不需要 CT 的患者，从而有机会在特定患者中安全地减少 CT 成像的使用。