Unilateral acute cervical lymphadenitis in children: can we predict the need for surgery?
Ricardo Matos1, Sónia Martins1, Pedro Marques1
1Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Department of Surgery and Physiology/Otorhinolaryngology, University of Porto Medical School, Portugal.
Insights
Predicting the need for surgery in pediatric acute cervical lymphadenitis is challenging. Surgical drainage in suppurative cervical lymphadenitis (SCL) did not show improved outcomes compared to non-surgical management.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Infectious Diseases
Background:
- Acute cervical lymphadenitis (ACL) is common in children.
- Distinguishing suppurative (SCL) from non-suppurative (NSCL) forms is difficult.
- Current guidelines lack criteria for imaging in ACL.
Purpose of the Study:
- Assess predictors and benefits of surgical management for SCL in children.
- Compare epidemiological, clinical, biochemical, and radiological features of NSCL and SCL.
Main Methods:
- Retrospective study of 42 pediatric patients with ACL (2007-2016).
- Patients categorized into NSCL and SCL groups.
- SCL group further divided into surgical and non-surgical subgroups based on drainage.
Main Results:
- No significant differences in demographics or antibiotic history between SCL and NSCL.
- Odynophagia was more frequent in NSCL (p=0.01).
- Submandibular lymphadenitis increased odds of suppuration by 16 times (p=0.029).
- Lymphadenitis size/location did not predict need for surgery in SCL.
- Surgical SCL group showed a trend towards longer hospitalization (p=0.01).
- One death occurred in the non-surgical SCL group.
Conclusions:
- No predictive factors for surgery were identified.
- Surgical drainage did not demonstrate improved outcomes.
- Surgery may be considered selectively for stable patients when medical treatment fails.
Introduction:
Paediatric acute cervical lymphadenitis is a frequent diagnosis in the emergency department. Traditionally, suppurative cervical lymphadenitis (SCL) is associated with a higher need of surgical drainage. However, a great variability in the management of this suppurative infections can be observed. Moreover, the clinical distinction between non-suppurative cervical lymphadenitis (NSCL) and SCL is not an easy task and there are, currently, no guidelines defining which patients are eligible for imaging study.
Objectives:
To assess the determinants and benefits in the surgical management of SCL in children. As secondary outcome, to determine differences in epidemiological characteristics, clinical, biochemical and radiological features between NSCL and SCL.
Material And Methods:
A retrospective survey was carried out in a tertiary university hospital between January 2007 and December 2016. Forty-two children with a diagnosis of acute cervical lymphadenitis (ACL) were included and categorized according to the presence of suppuration, resulting in two groups: NSCL and SCL. The latter group was further categorized into surgical and non-surgical groups, according to the need of surgical drainage.
Results:
No significant differences were found between SCL and NSCL groups in gender, age and previous antibiotics intake (p > 0.05). According to clinical presentation, odynophagia was significantly more frequent in NSCL patients (p = 0.01), with no differences found in other clinical parameters (p > 0.05). Patients presenting acute cervical lymphadenitis involving the submandibular region have 16 times the odds of a suppurative process (p = 0.029). In a SCL subgroup analysis, no association was observed between lymphadenitis size or location and the need for surgical drainage (p > 0.05). Children included in the SCL surgical group presented a trend to an increased in the hospitalization length (p = 0.01), when comparing to those in which treatment was limited to intravenous antibiotics. One death was observed in the SCL non-surgical group.
Conclusions:
Predictive factors for the need of surgery were not found. Furthermore, surgical drainage was not associated with better outcomes. Surgery could be considered in selected stable patients, when alternative medical treatments do not seem to work, in a case-to-case basis.
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