Complications in Pediatric Deep Neck Space Abscesses

Abstract

Objectives. To determine the incidence and demographic profile of children who develop complications from deep neck space abscess. Study Design. Case series. Setting. Tertiary children’s hospital. Subjects and Methods. One hundred thirty-eight patients admitted for deep neck space abscesses between 1998 and 2008. Inclusion criteria were age younger than 18 years and computed tomography scan demonstrating an abscess in the retropharyngeal, parapharyngeal, or peritonsillar spaces. Children were diagnosed with abscess if purulence was encountered on operative incision and drainage. Results. In the first 5 years of the study, 45 children met the inclusion criteria, whereas in the latter 5 years, 93 children were treated for abscesses. There were no differences between these cohorts in terms of age ( P = .70), gender ( P = .08), abscess site ( P = .23), or rate of surgical intervention ( P = .83). The total major complication rate was 9.4% (n = 13) with mediastinitis being the most frequent (n = 9) complication. The number of complications between the first (n = 3) and second (n = 10) groups was not significantly different ( P = .55). The factors that predisposed patients to develop complications were younger age at presentation and retropharyngeal abscess location. Children with complications were more likely to have Staphylococcus aureus identified as the causative organism ( P = .007). Only 1 of 4 children with methicillin-resistant S aureus had a complicated clinical course. Conclusions. Deep neck space abscesses continue to cause significant morbidity in children. Factors that predict complications include young age, retropharyngeal location, and S aureus. Providers must maintain a high index of suspicion to promptly diagnose and treat these complications.