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Clinical Characteristics and Resource Utilization in Children Presenting to the Pediatric Emergency Department With
Sofia S Cook1, Breahn F Donaldson1, Pradip P Chaudhari1,2
1Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles.
Insights
Neck swelling in children presenting to the emergency department (ED) often involves imaging, even for conditions like reactive lymphadenopathy and adenitis where patients are discharged home. This suggests imaging may not always be necessary for these pediatric neck swelling cases.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Clinical Pediatrics
Background:
- Neck swelling is a common presentation in pediatric emergency departments (EDs).
- Diagnostic imaging practices and resource utilization for pediatric neck swelling require further characterization.
Purpose of the Study:
- To describe patient demographics, diagnostic imaging rates, and resource utilization in children presenting to the ED with neck swelling.
- To identify factors associated with undergoing imaging for pediatric neck swelling.
Main Methods:
- Retrospective, single-center, cross-sectional chart review of children under 18 years old.
- Data collected from January 1, 2018, to December 31, 2018, for ED encounters with neck swelling diagnoses.
- Descriptive statistics and odds ratios were used to analyze characteristics and resource utilization.
Main Results:
- Of 680 encounters, 32.4% involved neck imaging (ultrasound, CT, or plain film).
- Fever, recent antibiotic use, and neck tenderness increased odds of imaging.
- 15.4% of reactive lymphadenopathy and 32.9% of adenitis cases underwent imaging, with most patients discharged home.
- ED length of stay was longer for encounters with imaging (3.6 hours) versus without (1.9 hours).
Conclusions:
- Patient characteristics and physical exam findings vary in children with neck swelling.
- Imaging may be overutilized in pediatric neck swelling cases, particularly for reactive lymphadenopathy and adenitis.
- Further research is needed to establish guidelines for appropriate imaging and modality selection in pediatric neck swelling.
Objectives:
We aimed to describe patient characteristics, diagnostic imaging rates, and resource utilization in children presenting to the emergency department (ED) with neck swelling.
Methods:
We conducted a single-center retrospective cross-sectional chart review study of children <18 years seen in a pediatric ED in the United States between January 1, 2018, and December 31, 2018, with a discharge diagnosis related to neck swelling. The primary outcome was neck imaging performed in the ED. We used descriptive statistics to describe clinical characteristics and odds ratios to compare resource utilization between ED encounters with and without imaging.
Results:
We studied 680 ED encounters with neck swelling, 32.4% (n=220) of which involved imaging. When imaging was ordered, ultrasound, computed tomography, or plain film radiography was ordered in 79% (n=180), 18.4% (n=43), and 4.7% (n=11) of encounters, respectively. Patients with fever (OR: 1.55, 95% CI: 1.11, 2.15), recent antibiotic use (OR: 1.8, 95% CI: 1.25, 2.6), and neck tenderness on physical examination (OR: 3.01, 95% CI: 2.11, 4.3) had increased odds of undergoing imaging. A subanalysis demonstrated that 15.4% (n=37) of patients with reactive lymphadenopathy and 32.9% (n=71) of patients with adenitis were imaged, despite over 95% of these patients being discharged home. Among all patients discharged home (n=570), median [IQR] ED length of stay was 3.6 [2.7, 5.4] hours in encounters with imaging and 1.9 [1.1, 3.4] hours in encounters without imaging (OR: 1.4; 95% CI: 1.3-1.5).
Conclusions:
Historical characteristics and physical examination findings vary among children presenting to the ED with neck swelling, including among those who undergo imaging. Children diagnosed with reactive lymphadenopathy and adenitis are typically discharged home from the ED, whether or not imaging was performed, suggesting that imaging may not always be necessary in these patients. Future studies are needed to understand which presenting signs and symptoms should lead to neck imaging and which imaging modality is best.
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