Variability in advanced imaging of pediatric neck infections in US emergency departments

OBJECTIVES

To describe the use of computed tomography (CT) and ultrasound (US) imaging for the evaluation of neck infections in pediatric patients in United States emergency departments (EDs).

METHODS

This is a cross-sectional analysis, using the National Emergency Department Sample database, of pediatric patients evaluated for common neck infections between 2012 and 2018. We used bivariable analysis to assess for differences in US and CT use by ED type. We performed multivariable logistic regression to adjust for potential confounding factors including patient characteristics (sex, age, insurance status, discharge diagnosis) and ED characteristics (metropolitan statistical area, pediatric center). Results are reported as odds ratios and adjusted odds ratios with 95% confidence intervals.

RESULTS

There were 19,363 ED visits for pediatric neck infections in the database over the study period, representing 84,439 national visits. Of those imaged, 80.8% were imaged with CT and 19.2% were imaged with US. Pediatric patients evaluated in general EDs as compared to pediatric EDs (aOR 5.32, 95% CI 3.06, 9.24) and patients with a diagnosis of peritonsillar abscess (aOR 2.11, 95% CI 1.34, 3.33) and retropharyngeal abscess (aOR 6.12, 95% CI 2.14, 17.53) were more likely to be imaged with CT scan.

CONCLUSIONS

Children with neck infections evaluated in general EDs are significantly more likely to undergo CT scans when compared to those evaluated in pediatric EDs. To reduce exposure to radiation in children, we propose the dissemination of US-first protocols in general EDs for the evaluation of pediatric neck infections.

Head and neck infections in children due to Eikenella corrodens: Report of three cases and review of literature

INTRODUCTION

Eikenella corrodens is a small, nonmotile Gram-negative rod that is part of the normal flora in the mouth, upper respiratory, gastrointestinal, and genitourinary tracts. It is classically found in human bite (fist to mouth) infections but is also seen in respiratory tract and head and neck infections.

METHODS

We describe three cases of E. corrodens causing head and neck infections in children seen in our institution between 2013 and 2019. We also reviewed the available literature on pediatric head and neck infections caused by E. corrodens.

RESULTS

All 3 children recovered and fit the trends identified in the 58 patients published in the literature from 1976 to 2019.

CONCLUSIONS

E. corrodens is responsible for a range of head and neck infections in pediatric patients. It is a not infrequent cause of head and neck infections in children and should be considered when selecting presumptive antibiotic therapy.

Computed tomography imaging of acute neck inflammatory processes

Early diagnosis and management of neck infections and inflammatory processes is a common challenge for emergency and ear, neck and throat physicians, as well as radiologists. Emergency neck infections are diverse in their presentation, ranging from a transient enlargement of a lymph node to a rapidly spreading necrotizing fasciitis. Symptoms and signs, with the clinical history, usually suggest the diagnosis. But complex neck anatomy and sometimes limited physical examination can obscure and delay diagnosis, thus the need for an appropriate imaging exam and correct interpretation. In this pictorial review, we will consider common neck acute inflammatory processes that may be encountered in the emergency room and discuss some of their salient imaging findings.

Necrotizing fasciitis of the neck associated with Lemierre syndrome

Necrotizing fasciitis of the head and neck is a rare, life-threatening, soft tissue infection rapidly involving superficial fat and fascia with necrosis of the overlying skin. If septic thrombophlebitis of the internal jugular vein complicates a parapharyngeal abscess, the clinical condition is referred to as Lemierre syndrome, also known as post-anginal sepsis. A lethal case of necrotizing fasciitis of the neck is herewith reported that developed following tooth extraction and was complicated by thrombosis of the internal jugular vein and superior vena cava in an elderly diabetic patient.