title: A prospective, blinded comparison of clinical examination and computed tomography in deep neck infections.
abstract: OBJECTIVE
  To determine whether there is a scientific basis for the routine use of contrast-enhanced computed tomography (CECT) in the evaluation of suspected deep neck infection (DNI).
  
  
  METHODS
  We conducted a prospective, blinded comparison of clinical examination and CECT in DNI.
  
  
  METHODS
  Thirty-five consecutive patients with suspected DNI were prospectively assessed by clinical examination and CECT for the presence and extent of surgically drainable purulent collections. Before CECT a surgeon recorded clinical data and predicted the extent of infection. A head and neck neuroradiologist, blinded to the clinical evaluation, predicted the extent of infection based on CECT. Final outcome (the presence of a purulent collection) was determined at surgery or in long-term follow-up. The clinical and CECT findings were compared with the final outcome to determine the sensitivity, specificity, and accuracy of each modality.
  
  
  RESULTS
  Twenty patients had purulent drainable collections. The accuracy of clinical examination alone in identifying a drainable collection was 63%, the sensitivity was 55%, and the specificity was 73%. The accuracy of CECT alone was 77%, the sensitivity was 95%, and the specificity 53%. When CECT and clinical examination were combined, the accuracy in identifying a drainable collection was 89%, the sensitivity was 95%, and the specificity 80%. If fluid collections with volumes of 2 mL or greater on CECT were considered, the accuracy of CECT would have been 85%, the sensitivity 89%, and the specificity 80%.
  
  
  CONCLUSIONS
  CECT and clinical examination are both critical components in the evaluation of suspected DNI.
authors.affiliation: Department of Medical Imaging, The University of Toronto, Ontario, Canada.
authors.forename: W D
authors.initials: WD
authors.lastname: Miller
authors.forename: I M
authors.initials: IM
authors.lastname: Furst
authors.forename: G K
authors.initials: GK
authors.lastname: Sàndor
authors.forename: M A
authors.initials: MA
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D010808:Physical Examination; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*