Long Michelle, Reddy Deepti N, Akiki Salwa, Barrowman Nicholas J, Zemek Roger
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario.
University of Ottawa, Ottawa, Ontario.
Paediatr Child Health. 2019 Sep 21;25(8):534-542. doi: 10.1093/pch/pxz125. eCollection 2020 Dec.
To describe clinical characteristics and management of acute lymphadenitis and to identify risk factors for complications.
Health record review of children ≤17 years with acute lymphadenitis (≤2 weeks) in a tertiary paediatric emergency department (2009-2014); 10% of charts were reviewed by a blinded second reviewer. Multivariate logistic regression identified factors associated with intravenous antibiotic treatment, unplanned return visits warranting intervention, and surgical drainage.
Of 1,023 health records, 567 participants with acute lymphadenitis were analyzed. The median age = 4 years (interquartile range [IQR]: 2 to 8 years), and median duration of symptoms = 1.0 day (IQR: 0.5 to 3.0 days). Cervical lymphadenitis was most common. Antibiotics were prescribed in 73.5% of initial visits; 86.9% of participants were discharged home. 29.0% received intravenous antibiotics, 19.3% had unplanned emergency department return visits, and 7.4% underwent surgical drainage. On multivariate analysis, factors associated with intravenous antibiotic use included history of fever (odds ratio [OR]=2.07, 95% confidence interval [CI]: 1.11 to 3.92), size (OR=1.74 per cm, 95% CI: 1.44 to 2.14), age (OR=0.84 per year, 95% CI: 0.76 to 0.92), and prior antibiotic use (OR=4.45, 95% CI: 2.03 to 9.88). The factors associated with unplanned return visit warranting intervention was size (OR=1.30 per cm, 95% CI: 1.06 to 1.59) and age (OR=0.89, 95% CI: 0.80 to 0.97). Factors associated with surgical drainage were age (OR=0.68 per year, 95% CI: 0.53 to 0.83) and size (OR=1.80 per cm, 95% CI: 1.41 to 2.36).
The vast majority of children with acute lymphadenitis were managed with outpatient oral antibiotics and did not require return emergency department visits or surgical drainage. Larger lymph node size and younger age were associated with increased intravenous antibiotic initiation, unplanned return visits warranting intervention and surgical drainage.
描述急性淋巴结炎的临床特征及治疗方法，并确定并发症的危险因素。
对一家三级儿科急诊科（2009 - 2014年）中年龄≤17岁的急性淋巴结炎（病程≤2周）患儿的健康记录进行回顾；10%的病历由另一位不知情的审阅者进行复查。多因素逻辑回归分析确定与静脉使用抗生素、需要干预的非计划复诊以及手术引流相关的因素。
在1023份健康记录中，对567例急性淋巴结炎患儿进行了分析。中位年龄 = 4岁（四分位间距[IQR]：2至8岁），症状中位持续时间 = 1.0天（IQR：0.5至3.0天）。颈部淋巴结炎最为常见。73.5%的初诊患儿使用了抗生素；86.9%的患儿出院回家。29.0%的患儿接受了静脉抗生素治疗，19.3%的患儿有非计划的急诊科复诊，7.4%的患儿接受了手术引流。多因素分析显示，与静脉使用抗生素相关的因素包括发热史（比值比[OR]=2.07，95%置信区间[CI]：1.11至3.92）、淋巴结大小（每厘米OR=1.74，95% CI：1.44至2.14）、年龄（每年OR=0.84，95% CI：0.76至0.92）以及既往抗生素使用史（OR=4.45，95% CI：2.03至9.88）。与需要干预的非计划复诊相关的因素是淋巴结大小（每厘米OR=1.30，95% CI：1.06至1.59）和年龄（OR=0.89，95% CI：0.80至0.97）。与手术引流相关的因素是年龄（每年OR=0.68，95% CI：0.53至0.83）和淋巴结大小（每厘米OR=1.80，95% CI：1.41至2.36）。
绝大多数急性淋巴结炎患儿采用门诊口服抗生素治疗，无需复诊或手术引流。较大的淋巴结大小和较小的年龄与静脉使用抗生素起始率增加、需要干预的非计划复诊以及手术引流相关。
