Clinical and radiological predictors of retropharyngeal abscesses in deep neck infections

Retropharyngeal abscesses (RPAs) are severe deep neck infections that require rapid intervention to prevent life-threatening complications. This study aimed to evaluate the clinical, laboratory, and radiological risk factors that predict the need for intensive care unit (ICU) admission and surgical drainage in adult patients with RPAs.

A retrospective review was conducted on patients treated for RPAs at our center between January 2013 and December 2023. Of the 64 initial cases, 57 adults were included in the final analysis after excluding pediatric patients and incomplete records. We analyzed the impact of demographics, diabetes mellitus (DM) status, admission laboratory markers (C-reactive protein [CRP], white blood cell [WBC] count), and radiological abscess size on the necessity for ICU admission and surgical intervention. Additionally, Receiver Operating Characteristic (ROC) curves were generated to assess the predictive value of these variables for ICU admission.

The cohort's mean age was 37.7 ± 16.7 years, with 9 patients (15.8%) requiring ICU care. Multivariate logistic regression identified DM (OR = 3.61, 95% CI: 1.31-9.92, p = 0.01), admission CRP level (OR = 1.01, 95% CI: 1.00-1.02, p = 0.03), and maximum abscess diameter (OR = 1.09, 95% CI: 1.02-1.18, p = 0.02) as independent predictors of ICU admission. ROC analysis for CRP yielded an area under the curve (AUC) of 0.87; a 200 mg/L cut-off achieved 100% sensitivity and 80.9% specificity. Maximum abscess diameter demonstrated an AUC of 0.81, with a 30 mm cut-off providing 88.9% sensitivity and 71.4% specificity. None of the evaluated parameters significantly correlated with the need for surgical drainage.

Comorbid DM, elevated CRP levels, and larger abscess dimensions independently predict the need for intensive care in adults with RPAs. The strong discriminative capacity of admission CRP and radiological abscess size highlights their critical utility in early clinical risk stratification and guiding targeted treatment strategies.