Neck computed tomography in pediatric neck mass as initial evaluation in ED: is it malpractice?

Area of Science:

• Pediatric Radiology
• Emergency Medicine Imaging

Background:

• Ultrasound is standard for pediatric neck masses, but computed tomography (CT) is crucial for urgent surgical conditions like deep neck infections.
• Evaluating the diagnostic utility of neck CT as an initial imaging modality in the emergency department (ED) for pediatric neck masses is essential.

Purpose of the Study:

• To assess the diagnostic effectiveness of neck CT for initial evaluation of pediatric neck masses in the ED.
• To determine appropriate patient selection criteria for neck CT in this setting.

Main Methods:

• Retrospective analysis of 105 pediatric patients presenting to the ED with neck masses, with initial imaging via neck CT.
• Evaluation of patient demographics, symptoms, CT findings, final diagnoses, and treatments.
• Calculation of the positive predictive value (PPV) of CT and identification of predictors for urgent surgical conditions.

Main Results:

• The overall PPV of neck CT was 96.2% for pediatric neck masses.
• CT achieved 100% PPV for suspected deep neck infections, salivary gland infections, or tonsillitis.
• Fever and severe tenderness were significant indicators of urgent surgical conditions identified by CT.

Conclusions:

• Neck CT can be considered the primary imaging modality when urgent surgical conditions, such as deep neck infections, are strongly suspected in pediatric patients.
• CT provides high diagnostic accuracy and aids in timely management decisions for pediatric neck masses in the ED.