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Clinical characteristics for conservative therapy of pediatric parapharyngeal abscesses
Jing Bi1, Xiaowei Chen1, Zhiying Zhou1
1Children's Hospital of Zhejiang University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Hangzhou, China.
Insights
Younger children with smaller parapharyngeal abscesses and fewer preceding illnesses respond best to conservative therapy. This finding aids in determining appropriate treatment for pediatric parapharyngeal abscesses.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Infectious Diseases
Background:
- Debate exists regarding surgical drainage versus conservative therapy for parapharyngeal abscesses.
- Conservative therapy is a viable option for select pediatric patients.
Purpose of the Study:
- To identify characteristics predicting successful conservative therapy for pediatric parapharyngeal abscesses.
- To establish age and abscess size cutoffs for conservative treatment success.
Main Methods:
- Retrospective chart review of 48 pediatric patients diagnosed with parapharyngeal abscesses.
- Analysis of clinical characteristics, including age, antecedent illness, and abscess size.
- Multivariate logistic regression and ROC curve analysis to determine predictive factors and cutoffs.
Main Results:
- Younger age (cutoff 4.2 years), smaller abscess size (cutoff 23mm), and fewer antecedent illnesses predicted successful conservative therapy.
- Age, antecedent illness, and abscess size were significantly associated with treatment response.
Conclusions:
- Conservative therapy can be effective for pediatric parapharyngeal abscesses in carefully selected patients.
- Younger age, smaller abscess size, and absence of significant antecedent illnesses are key indicators for successful conservative management.
Introduction:
The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate.
Objectives:
This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy.
Methods:
This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response.
Results:
A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio=1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23mm (84.6% sensitivity, 77.3% specificity).
Conclusion:
The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.
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