Deep space neck abscess is one of the leading causes of pediatric emergency consultation for the Pediatric Otolaryngologists. These infections often require prompt surgical incision and drainage. However, in recent years, many patients have been successfully managed with intravenous antibiotics and careful observation. Computed tomography (CT) of the neck is the most common imaging modality for the evaluation of possible neck abscesses in children, which often requires sedation or general anesthesia. With the increasing concern for ionizing radiation exposure in children, the utilization of CT has come under increasing scrutiny. The purpose is to review the diagnostic work-up of patients who present with a possible neck abscess and the utilization of neck CT. We compared initial presenting symptoms, and imaging results of the patients who were discharged home, admitted for IV antibiotics vs. those who required surgery in order to identify any significant differences in the cohorts that may serve as predictors in the future.

A retrospective review of the electronic medical records of patients evaluated in the Rady Children’s Hospital emergency department that received a neck CT between 7/1/2011 and 6/30/2013 was performed. The clinical presenting symptoms, radiographic findings, and subsequent management were reviewed. The outcomes and complications of the discharged, medical, and surgical groups were compared. Data analysis using ANOVA helped identify significant factors associated with positive CT finding and subsequent need for surgery. IRB approval was obtained from the University of California San Diego.

A total of 154 patients met the inclusion criteria with an average age of 6.98 years. Of these, 72 (46.8%) had a negative CT scan and were subsequently discharged home from the emergency department. Of the patients who were admitted, only 25 required surgical drainage (16.2%) and 57 (37.0%) were treated successfully with medical therapy. There was no significant difference in patients’ age among the three groups. Among the presenting symptoms, there was no significant difference in length of symptoms, sore throat, torticollis or neck pain. However, neck swelling is a significant predictor of positive CT finding and subsequent surgery (p=0.0004) and fever was reported most often in patients who were successfully treated by medication (p=0.0002). There was no significant complications reported in any group and ED revisit and re-admission rates were low in the cohort.

We feel that CT may be over utilized in the evaluation of children with possible neck abscess presenting to the emergency department. Clinical presentation of neck swelling is highly predictive of the need for surgical drainage. A diagnostic algorithm maybe optimized in the future for children with neck swelling with early consultation of the Otolaryngology service prior to imaging. Alternative imaging modalities such as neck ultrasound (US) should also be considered.