Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
Children's Hospital Association, Overland Park, Kansas.
Pediatrics. 2021 Nov;148(5). doi: 10.1542/peds.2020-037010. Epub 2021 Oct 25.
Treatment of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) includes antibiotics, with possible surgical drainage. Although corticosteroids may decrease inflammation, their role in the management of RPAs and PPAs is unclear. We evaluated the association of corticosteroid administration as part of initial medical management on drainage rates and length of stay for children admitted with RPAs and PPAs.
We conducted a retrospective study using administrative data of children aged 2 months to 8 years discharged with RPAs and PPAs from 2016 to 2019. Exposure was defined as systemic corticosteroids administered as part of initial management. Primary outcome was surgical drainage. Bivariate comparisons were made between patients in the corticosteroid and noncorticosteroid groups by using Wilcoxon rank or χ tests. Outcomes were modeled by using generalized linear mixed-effects models.
Of the 2259 patients with RPAs and PPAs, 1677 (74.2%) were in the noncorticosteroid group and 582 (25.8%) were in the corticosteroid group. There were no significant differences in age, sex, or insurance status. There was a lower rate of drainage in the corticosteroid cohort (odds ratio: 0.28; confidence interval: 0.22-0.36). Patients in this group were more likely to have repeat computed tomography imaging performed, had lower hospital costs, and were less likely to have opioid medications administered. The corticosteroid cohort had a higher 7-day emergency department revisit rate, but there was no difference in length of stay (rate ratio 0.97; confidence interval: 0.92-1.02).
Corticosteroids were associated with lower odds of surgical drainage among children with RPAs and PPAs.
治疗咽后脓肿（RPA）和咽旁脓肿（PPA）包括使用抗生素，必要时进行手术引流。尽管皮质类固醇可能会减轻炎症，但它们在 RPA 和 PPA 治疗中的作用尚不清楚。我们评估了作为初始治疗一部分的皮质类固醇给药与接受 RPA 和 PPA 治疗的儿童的引流率和住院时间的关系。
我们使用 2016 年至 2019 年期间 2 个月至 8 岁儿童因 RPA 和 PPA 出院的行政数据进行了回顾性研究。暴露定义为作为初始治疗一部分给予的全身皮质类固醇。主要结局为手术引流。使用 Wilcoxon 秩或 χ 检验比较皮质类固醇组和非皮质类固醇组患者之间的双变量。使用广义线性混合效应模型对结局进行建模。
在 2259 例 RPA 和 PPA 患者中，1677 例（74.2%）在非皮质类固醇组，582 例（25.8%）在皮质类固醇组。两组在年龄、性别或保险状况方面无显著差异。皮质类固醇组的引流率较低（优势比：0.28；95%置信区间：0.22-0.36）。该组患者更有可能接受重复 CT 成像检查，住院费用较低，且不太可能使用阿片类药物。皮质类固醇组 7 天内急诊科复诊率较高，但住院时间无差异（率比 0.97；95%置信区间：0.92-1.02）。
对于 RPA 和 PPA 患儿，皮质类固醇与手术引流的可能性降低相关。
