Golriz Farahnaz, Bisset George S, D'Amico Beth, Cruz Andrea T, Alade Kiyetta H, Zhang Wei, Donnelly Lane F
Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
Pediatr Radiol. 2017 Apr;47(4):422-428. doi: 10.1007/s00247-016-3774-9. Epub 2017 Jan 21.
To identify the association between clinical and ultrasound findings and surgical drainage in children with inflammatory neck masses and to create a clinical decision rule that allows for reduction of unnecessary use of ultrasound in inflammatory neck masses.
We reviewed data on patients ≤18 years who visited our emergency department between 2012 and 2014 with inflammatory neck swelling and who underwent ultrasound examinations of the neck. We used multivariate logistic regression to identify factors associated with drainage within 24 h of ultrasound study (early drainage). Recursive partitioning was used for risk stratification.
Of 341 consecutive patients included in this study, 37 patients underwent early drainage and all had purulent material drained. All patients but one with non-suppurative adenitis and 95% (97/102) of those with suppurative adenitis or early/suspicious abscess on ultrasound were initially treated medically. Of those with a definite diagnosis of abscess/fluid collection, 89% (32/36) underwent early drainage. Patients who underwent drainage were more likely to be younger, female and have a longer duration of neck swelling, with fluctuance and erythema on exam. Recursive partitioning analysis revealed that among children with neck swelling >3 days and ≤3 days, the rate of early drainage was 24.3% and 4.4%, respectively. None of the children >7 months with neck swelling ≤3 days underwent early drainage.
Children older than 1 year with inflammatory neck swelling ≤3 days are at low risk of having ultrasound findings that require drainage. In this subgroup of patients, ultrasound could be avoided unless the patient fails to improve after a trial of antibiotic therapy.
确定炎症性颈部肿块患儿的临床及超声检查结果与手术引流之间的关联，并制定一项临床决策规则，以减少炎症性颈部肿块患儿不必要的超声检查。
我们回顾了2012年至2014年间因炎症性颈部肿胀就诊于我院急诊科且接受颈部超声检查的18岁及以下患者的数据。我们使用多因素逻辑回归分析来确定与超声检查后24小时内进行引流（早期引流）相关的因素。采用递归划分法进行风险分层。
本研究纳入的341例连续患者中，37例接受了早期引流，所有患者均引出了脓性物质。除1例非化脓性腺炎患者外，所有患者以及超声检查显示为化脓性腺炎或早期/可疑脓肿的患者中95%（97/102）最初接受了药物治疗。明确诊断为脓肿/液体积聚的患者中，89%（32/36）接受了早期引流。接受引流的患者更可能年龄较小、为女性，颈部肿胀时间较长，检查时有波动感和红斑。递归划分分析显示，颈部肿胀>3天和≤3天的儿童中，早期引流率分别为24.3%和4.4%。颈部肿胀≤3天的7个月以上儿童均未接受早期引流。
1岁以上炎症性颈部肿胀≤3天的儿童，其超声检查结果需要引流的风险较低。在这一亚组患者中，除非患者在抗生素治疗试验后无改善，否则可以避免进行超声检查。
