Children's Hospital of Zhejiang University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Hangzhou, China.
Children's Hospital of Zhejiang University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Hangzhou, China.
Braz J Otorhinolaryngol. 2021 Jul-Aug;87(4):410-415. doi: 10.1016/j.bjorl.2019.10.015. Epub 2019 Dec 23.
The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate.
This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy.
This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response.
A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio=1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23mm (84.6% sensitivity, 77.3% specificity).
The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.
外科引流与保守治疗在治疗咽旁脓肿患者中的作用仍存在争议。
本研究旨在探讨接受保守治疗的儿童咽旁脓肿患者中与良好结局相关的特征。
本回顾性图表研究纳入了 2013 年 1 月至 2018 年 3 月期间经 CT 确诊为咽旁脓肿且年龄在 0.3-14 岁的儿童患者。需要早期干预严重上呼吸道阻塞的患者，而病情稳定的患者最初接受抗生素保守治疗。如果患者不太可能康复，则提供额外的外科引流。构建多变量逻辑回归模型以研究与保守治疗良好反应相关的临床特征。使用受试者工作特征曲线确定预测成功反应的年龄和脓肿大小截止值。
本研究共纳入了 48 例儿童患者。患者年龄、既往疾病和脓肿大小与治疗反应显著相关（比值比分别为 1.326、2.314 和 1.235）。与保守治疗相关的年龄截止值为 4.2 岁（76.9%的敏感性，68.2%的特异性），与保守治疗相关的脓肿大小截止值为 23mm（84.6%的敏感性，77.3%的特异性）。
这些发现表明，年龄较小、脓肿较小以及较少发生上呼吸道感染和淋巴结炎等既往疾病的儿童咽旁脓肿患者可能对保守治疗有良好的反应。
