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Prognostic Factors for Retropharyngeal Abscess in Children Receiving Surgery or Antibiotic Therapy
Yupeng Liu1, Dante J Nicotera1, Aseeyah A Islam1
1Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A.
Insights
Retropharyngeal abscess (RPA) management in children can be guided by imaging. Computed tomography (CT) rim enhancement strongly predicts successful surgical drainage, though clinical features do not.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Radiology
Background:
- Retropharyngeal abscess (RPA) is a serious infection in children.
- Effective management requires identifying factors predicting treatment success.
- Surgical intervention is common, but non-surgical options are also utilized.
Purpose of the Study:
- To analyze characteristics and outcomes of pediatric RPA patients.
- To identify prognostic factors for successful surgical intervention in RPA.
- To determine predictors of positive surgical drainage.
Main Methods:
- Retrospective financial database search for pediatric RPA patients (2010-2021).
- Review of medical charts for demographics, clinical presentation, imaging, and surgical findings.
- Bivariate and multivariate analyses to identify predictors of positive drainage.
Main Results:
- Of 245 patients, 65% received surgery. Restricted cervical motion, neck swelling, and CT cross-sectional area >2 cm² predicted surgery.
- Computed tomography (CT) rim enhancement was significantly associated with positive surgical drainage (OR 2.58).
- No clinical symptoms or physical exam findings predicted drainage; CT rim enhancement was the only significant predictor in multivariate analysis.
Conclusions:
- Medical management of RPA shows a high success rate.
- Clinical features are not significant predictors of surgical outcomes.
- CT findings, specifically rim enhancement, are strongly associated with positive surgical drainage in pediatric RPA.
Objective:
Effective management of retropharyngeal abscess (RPA) may predicate upon identification of key patient characteristics. We analyzed characteristics and outcomes of pediatric patients with RPA to identify prognostic factors associated with successful surgical intervention.
Methods:
A financial database was searched for pediatric otolaryngology patients with RPA from 2010 to 2021. Medical charts were reviewed for demographics, presenting history, physical examination, laboratory testing, imaging, surgical findings, and hospital course. Bivariate analyses were performed to identify potentially significant predictors of positive drainage. These variables were included in multivariate analysis of surgical outcomes.
Results:
Of 245 total patients, 159 patients (65%) received surgery and 86 patients (35%) received antibiotics only. Patients with restricted cervical motion, neck swelling, and computed tomography (CT) cross-sectional area (CSA) >2 cm2 were more likely to receive surgery. Rim enhancement on CT imaging was associated with positive surgical drainage (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.16-5.74). However, no variables from clinical symptoms or physical exam were associated with positive drainage. Variables that approached significance were included in multivariate analysis, which revealed only rim enhancement predicted positive drainage (OR 2.57, 95% CI 1.13-5.83). The mean length of stay (LOS) was 2.6 versus 3.5 days (p < 0.001) for medical vs surgical treatment groups, respectively.
Conclusion:
Our study revealed a high success rate of medical management. Although patient characteristics and clinical features were not significant predictors of surgical outcomes, CT findings such as rim enhancement were strongly associated with positive surgical drainage.
Level Of Evidence:
2 Laryngoscope, 134:1955-1960, 2024.
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