Risk Factors for Pediatric Deep Neck Infection Revisit After Emergency Department Discharge for Pharyngitis or...

Diagnosis of deep neck space infections is challenging in children due to subtle symptoms and examination findings. However, delays in diagnosis can contribute to increased morbidity in pediatric deep neck space infection. We aimed to determine (1) the most frequent discharge diagnoses associated with emergency department (ED) visits in the 10 days before deep neck space infection diagnosis and (2) use cohorts of pediatric ED visits with these frequent diagnoses to determine factors associated with return admission with deep neck space infection.

Cross-sectional analysis of ED and inpatient visits for ages less than 18 years from the State Emergency Department and State Inpatient Datasets from 2018-2019. We linked deep neck space infection admissions (identified by primary International Classification of Diseases, Tenth Revision diagnosis J390) to 10-day antecedent ED visits and identified the most frequent discharge diagnoses in these visits. We then analyzed cohorts of ED encounters with these frequent discharge diagnoses: 1) localized neck symptoms (pain, mass, or torticollis), and 2) pharyngitis or tonsillitis; and compared patient and hospital characteristics of visits with and without a subsequent 10-day admission for deep neck space infection using descriptive statistics. Firth logistic regression was used to assess patient and hospital predictors of a deep neck space infection revisit.

Among 799 pediatric deep neck space infection admissions included in the study, 146 (18.3%) patients had more than or equal to 1 treat-and-release ED visits in the 10-day window before deep neck space infection admission. In the cohorts of ED treat-and-release visits for pharyngitis/tonsillitis (n=419,660) and localized neck symptoms (n=54,779), 10-day return visits for deep neck space infection were rare, representing 0.01% and 0.07% of visits, respectively. ED visits with neck imaging were associated with deep neck space infection revisit for both cohorts. Predictors of deep neck space infection in the localized neck symptoms cohort also included younger age and an ED diagnosis of fever, whereas in the pharyngitis cohort, deep neck space infection revisit was associated with ED diagnosis of localized neck symptoms, and negatively associated with a diagnosis of upper respiratory infection or respiratory symptoms.

In ED encounters where patients were discharged with neck pain/mass or torticollis, younger age and a diagnosis of fever were associated with a subsequent deep neck space infection admission. Among ED patients discharged with pharyngitis/tonsillitis, absence of upper respiratory infection/respiratory diagnosis, and neck pain/mass/or torticollis were associated with increased risk of return admission for deep neck space infection. Increased clinical suspicion for deep neck space infection (as manifested by laboratory findings/neck imaging at initial ED visit) was associated with increased risk of deep neck space infection revisit, representing an area for future research. Findings should be validated in datasets with more detailed clinical documentation.