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Variation in the Management of Children With Deep Neck Infections
Susan C Lipsett1,2, John J Porter2, Michael C Monuteaux3,2
1Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and susan.lipsett@childrens.harvard.edu.
Insights
Management of pediatric deep neck infections (DNIs) varies significantly across US hospitals. While surgical rates are declining, non-surgical approaches show promise, with higher initial medical management linked to lower failure rates.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Management
- Surgical Outcomes
Background:
- Deep neck infections (DNIs) in children are increasingly managed non-surgically with antibiotics.
- Significant variation exists in the management of pediatric DNIs across US children's hospitals.
Purpose of the Study:
- To examine variations in the management of pediatric deep neck infections (DNIs) across US children's hospitals.
- To analyze temporal trends in management modalities and compare outcomes between medical and surgical approaches.
Main Methods:
- Retrospective cohort study using the Pediatric Health Information System database (2010-2018).
- Included children ≤12 years hospitalized for retropharyngeal or parapharyngeal abscesses.
- Analyzed hospital variation in management, imaging, temporal trends, and outcomes of medical vs. surgical management.
Main Results:
- Hospital rates of surgical management varied widely (17%-70%) and decreased over time (42.0% to 33.5%).
- Surgically managed children had higher ICU admission rates and hospital charges compared to medically managed children.
- Hospitals with higher initial medical management rates showed lower rates of medical management failure.
Conclusions:
- Pediatric DNI surgical management rates are decreasing, but significant hospital variation persists.
- Surgical management is associated with increased resource utilization and costs.
- Higher rates of initial medical management correlate with lower failure rates, suggesting potential for non-surgical approaches.
Background And Objectives:
Children with deep neck infections (DNIs) are increasingly being managed nonsurgically with intravenous antibiotics. Our objective was to examine variation in the management of children with DNIs across US children's hospitals.
Methods:
We conducted a retrospective cohort study using the Pediatric Health Information System database. Children ≤12 years of age hospitalized for retropharyngeal or parapharyngeal abscesses from 2010 to 2018 were included. Hospital variation in management modality and imaging use was described. Temporal trends in management modality were assessed by using logistic regression. Medical management alone versus a combination of medical and surgical management was assessed, and the characteristics of children in these 2 groups were compared. The relationship between hospital rates of initial medical management and failed medical management was assessed by using linear regression.
Results:
Hospitals varied widely in their rates of surgical management from 17% to 70%. The overall rate of surgical management decreased from 42.0% to 33.5% over the study period. Children managed surgically had higher rates of ICU admission (11.5% vs 3.2%; P < .001) and higher hospital charges ($25 241 vs $15 088; P < .001) compared with those managed medically alone. Seventy-three percent of children underwent initial medical management, of whom 17.9% went on to undergo surgery. Hospitals with higher rates of initial medical management had lower rates of failed medical management (β = -.43).
Conclusions:
Although rates of surgical management of pediatric DNI are decreasing over time, there remains considerable variation in management across US children's hospitals. Children managed surgically have higher rates of resource use and costs.
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