Department of Pediatrics, Emory University, Atlanta, GA 30329, USA.
Am J Emerg Med. 2013 Jun;31(6):906-9. doi: 10.1016/j.ajem.2013.02.043. Epub 2013 May 14.
Superficial neck infections including lymphadenitis and abscesses are commonly encountered in pediatric emergency departments (PEDs). It is often unclear which patients are likely to develop an abscess that necessitates surgical drainage. In evaluating these patients, computed tomography (CT) and ultrasound are often used to identify/confirm abscess formation. The criteria for determining the need for imaging studies are not well defined.
DESIGN/METHODS: All visits to the study PED were examined in 2009 to 2010. Visits with the diagnosis of cervical lymphadenitis or abscess were identified. Records were retrospectively reviewed to determine the duration of symptoms, fever, previous antibiotic therapy, prior PED visit, size of neck swelling, fluctuance on physical examination, white blood cell count, and results of CT and/or ultrasound obtained in the PED. Data were analyzed to determine which of these characteristics were more likely to be associated with an abscess that was operatively drained.
A total of 768 patients were evaluated for neck infections. One hundred twelve (14%) of these pediatric patients underwent abscess drainage in the operating room. Two hundred eighty-nine patients underwent a neck CT and/or ultrasound, of which 119 were positive for abscess. Factors associated with surgical drainage included fluctuance (odds ratio [OR], 18.92; 95% confidence interval [CI], 3.66-31.37), previous emergency department visit (OR, 2.79; 95% CI, 1.34-5.84), and age less than 4 years (OR, 3.01; 95% CI, 1.15-9.87). A recursive partitioning model stratified patients' risk for going to the operating room. Patients without fluctuance and with no prior emergency department visit, along with no prior antibiotic use, have less than 4% chance of having an abscess that necessitates surgical drainage.
Pediatric patients who are more likely to have a neck infection that necessitates surgical drainage can be stratified based on clinical characteristics. This knowledge may allow physicians to better predict the resource needs including hospital admission and emergent imaging for neck infection.
在儿科急诊室（PED）中，常见的浅表颈部感染包括淋巴结炎和脓肿。通常不清楚哪些患者可能会形成需要手术引流的脓肿。在评估这些患者时，通常使用计算机断层扫描（CT）和超声来识别/确认脓肿形成。用于确定是否需要进行影像学研究的标准尚未明确。
方法/设计：在 2009 年至 2010 年期间，对研究 PED 的所有就诊进行了检查。确定了患有颈淋巴结炎或脓肿的就诊记录。回顾性审查记录，以确定症状持续时间、发热、先前的抗生素治疗、先前的 PED 就诊、颈部肿胀的大小、体格检查时的波动感、白细胞计数以及在 PED 获得的 CT 和/或超声结果。分析数据以确定这些特征中哪些更可能与需要手术引流的脓肿相关。
共有 768 名患者接受了颈部感染评估。其中 112 名（14%）儿科患者在手术室进行了脓肿引流。289 名患者进行了颈部 CT 和/或超声检查，其中 119 例为脓肿阳性。与手术引流相关的因素包括波动感（优势比[OR]，18.92；95%置信区间[CI]，3.66-31.37）、先前的急诊就诊（OR，2.79；95% CI，1.34-5.84）和年龄小于 4 岁（OR，3.01；95% CI，1.15-9.87）。一个递归分区模型对患者去手术室的风险进行了分层。没有波动感且没有急诊就诊史、没有先前使用抗生素的患者，其发生需要手术引流的脓肿的可能性小于 4%。
可以根据临床特征对需要手术引流的颈部感染的儿科患者进行分层。这些知识可能使医生能够更好地预测资源需求，包括颈部感染的住院和紧急影像学检查。
