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Defining the role of surgical drainage in paediatric deep neck space infections
Author(s) -
Wilkie Mark D.,
De Sujata,
Krishnan Madhankumar
Publication year - 2019
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.13315
Subject(s) - medicine , abscess , radiological weapon , surgery , retrospective cohort study , referral , predictive value , cohort , family medicine
Objectives Surgical drainage is the traditional mainstay of treatment of paediatric deep neck space infection (DNSI), but recently non‐operative management in selected cases has been advocated. We sought to identify any characteristics predictive of requirement for surgical intervention. Design Retrospective cohort study using receiver operating characteristics analyses. Setting Tertiary referral paediatric hospital. Participants Children (≤16 years) with a radiologically confirmed diagnosis of retro‐ or parapharyngeal abscess over a ten‐year period. Main outcome measures Predictive value of clinical and radiological variables in determining the requirement for surgical intervention. Length of hospital stay (LoS) was also examined. Results Ninety‐three children were studied, 15 (16.1%) of whom underwent immediate surgery, 42 (45.2%) of whom underwent delayed surgery following an initial period of conservative management, and 36 (38.7%) of whom were managed conservatively. Age, WCC and CRP were not predictive of the need for surgical drainage. Radiological abscess diameter, however, was predictive of requirement surgery (AUC = 0.85 [95% CI ± 0.09] P = 0.02), with a cut‐off value of 2.5 cm determined assuming equal weight to sensitivity and specificity. All DNSIs were successfully treated with no adverse outcomes, and there was no significant difference in LoS between groups. In those managed surgically, outcome and LoS did not depend on yield of pus. Conclusions Selected paediatric DNSIs can be successfully managed conservatively, with abscess diameter >2.5 cm a significant predictor of need for surgical intervention. Any benefit of surgery does not appear to depend on intra‐operative yield of pus.