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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
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Risk Factors for Pediatric Deep Neck Infection Revisit After Emergency Department Discharge for Pharyngitis or

Kaileen Jafari1, Derya Caglar1, Apeksha Gupta2

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Pediatric deep neck space infections are challenging to diagnose. Factors like neck pain, fever, and lack of respiratory symptoms in initial emergency department visits increase the risk of readmission for deep neck space infections.

Keywords:
Deep neck infectionDiagnosisPediatricsSPADE

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Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Otolaryngology

Background:

  • Diagnosing deep neck space infections in children presents challenges due to subtle symptoms.
  • Delayed diagnosis of pediatric deep neck space infections can lead to increased morbidity.

Purpose of the Study:

  • Identify frequent emergency department (ED) diagnoses preceding pediatric deep neck space infection (DNSI).
  • Determine factors associated with readmission for DNSI in pediatric ED visits with common preceding diagnoses.

Main Methods:

  • Cross-sectional analysis of pediatric ED and inpatient data (2018-2019).
  • Linked DNSI admissions to 10-day antecedent ED visits.
  • Analyzed cohorts for pharyngitis/tonsillitis and localized neck symptoms, comparing characteristics of visits with and without subsequent DNSI admission.

Main Results:

  • 18.3% of pediatric DNSI admissions had prior ED visits within 10 days.
  • Return visits for DNSI were rare (0.01%-0.07%) in pharyngitis/tonsillitis and localized neck symptom cohorts.
  • Neck imaging during initial ED visits was associated with DNSI readmission for both cohorts.

Conclusions:

  • In pediatric ED visits for neck pain/mass/torticollis, younger age and fever predicted DNSI admission.
  • For pharyngitis/tonsillitis, absence of URI/respiratory diagnosis and presence of neck symptoms increased DNSI readmission risk.
  • Clinical suspicion indicators like neck imaging at initial ED visits correlate with increased DNSI revisit risk.