Pediatric deep space neck infections: the Medical College of Wisconsin experience

A retrospective review was performed on 39 patients with deep space neck infection admitted to the Children's Hospital of Wisconsin over a nine year period. The signs and symptoms as well as issues of diagnosis and treatment were reviewed with attention to the use of computed tomography (CT) scans. Beta hemolytic streptococcus was the most commonly cultured organism followed by alpha hemolytic streptococcus. Sixteen patients underwent CT scans. Twelve were diagnosed with an abscess by CT scan. An abscess was confirmed in ten patients. Necrotic lymph nodes mimicked abscesses on CT scans and resulted in negative surgical findings. Airway obstruction occurred in 30% of the children in the study. Children under the age of 36 months had a significantly higher rate of airway obstruction upon presentation compared to older children (P < 0.05). There should be a high index of suspicion of upper airway compromise in children under the age of 36 months with a deep neck infection.