Indicators of a more complicated clinical course for pediatric patients with retropharyngeal abscess.
OBJECTIVE
Determine clinical signs or symptoms associated with a more complicated clinical course in patients with retropharyngeal abscesses (RPAs).


METHODS
Retrospective chart review at a tertiary care level Children's hospital. Main Outcome Measures Age, presenting signs and symptoms, laboratory tests, imaging results, antibiotic therapy, surgical approach, pathogens isolated, and duration of hospitalization were evaluated to determine any factors associated with a more complicated clinical course (CCC).


RESULTS
Fifteen of one hundred thirty pediatric patients with RPA were identified with a complicated clinical course (CCC). Eight of the fifteen required more than one procedure before the abscess resolved. Patients with multiple abscess sites had a statistically significantly greater chance of requiring multiple procedures to clear the infections (p<0.001). Another seven presented with airway obstruction requiring an admission into the Pediatric Intensive Care (PICU) and/or intubation. All the patients requiring admission to the PICU presented with signs or symptoms of airway obstruction compared to ten of the one hundred fifteen patients (8.7%) with a smooth clinical course (SCC) (p<0.001). Five patients from the CCC group required a bronchoscopy to secure the airway; seven patients required intubation following incision and drainage of the abscess for an average of 5+/-3 days. There was no statistically significant difference between the two groups with respect to pathogens isolated, or antibiotics used.


CONCLUSIONS
Our study suggests that patients with a CCC are more likely to present with airway obstruction or multiple abscess sites than patients with SCC.
Elsherif
Abdelaziz M
AM
Division of Otolaryngology/Head and Neck Surgery, University of Utah, 50 North Medical Drive, 3C 120, Salt Lake City, UT 84132, United States.
Park
Albert H
AH
Alder
Stephen C
SC
Smith
Marshall E
ME
Muntz
Harlan R
HR
Grimmer
F
F
D000402:Airway Obstruction / Q000175:diagnosis / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009164:Mycobacterium Infections / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D017703:Retropharyngeal Abscess / Q000453:epidemiology / Q000382:microbiology* / Q000534:rehabilitation; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation; D013396:Suction
D000900:Anti-Bacterial Agents; D002981:Clindamycin