title: Pediatric deep space neck infections in U.S. children, 2000-2009.
abstract: OBJECTIVE
  Deep space neck infections (DNI) are common pediatric illnesses, which can lead to significant morbidity and healthcare expenditures. Recent studies suggest that the incidence of pediatric DNI in the United States is increasing, but no nationally representative studies exist. This study sought to characterize pediatric DNI at the national level over the past decade and to determine whether U.S. incidence of pediatric DNI and associated resource utilization changed from 2000 to 2009.
  
  
  METHODS
  The Kids' Inpatient Database (KID) was used to evaluate pediatric DNI incidence, demographics, and outcomes from 2000 to 2009. Cases were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes for peritonsillar abscess (475), parapharyngeal abscess (478.22), and retropharyngeal abscess (478.24). Regression analyses within each year and across the entire study period were performed on variables of interest including performance of imaging studies, operative intervention, length of hospital stay and total hospital charges.
  
  
  RESULTS
  The incidence of retropharyngeal abscess increased significantly from 0.10 cases per 10,000 in 2000 to 0.22 in 2009 (p=0.02). There was no significant change during this time period in the incidence of combined DNI (1.07-1.37 cases per 10,000, p=0.07), peritonsillar abscess (0.82-0.94 cases per 10,000, p=0.12) or parapharyngeal abscess (0.08-0.14 cases per 10,000, p=0.13). The percentage of retropharyngeal abscess patients managed surgically decreased (48-38%, p=0.04) and the average length of hospital stay also decreased during this time (4.6-3.9 days, p=0.03). There was a marked increase in the total inflation-corrected hospital charges per case for all DNI ($9,486-16,348, p=0.005).
  
  
  CONCLUSIONS
  The incidence of pediatric retropharyngeal abscess has increased significantly from 2000 to 2009, without concurrent increases in the incidence of combined DNI, peritonsillar, or parapharyngeal abscesses. There has been a change in management of retropharyngeal abscesses during this time with a decrease in operative intervention and a decrease in the length of hospital stay. Hospital charges associated with all pediatric DNI have nearly doubled during this timeframe, warranting future epidemiologic resource utilization studies in this population.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, United States. Electronic address: sarahnov@med.umich.edu.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Novis
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, United States.
authors.forename: Cedric V
authors.initials: CV
authors.lastname: Pritchett
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, United States.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Thorne
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, United States; Robert Wood Johnson Foundation Clinical Scholars, University of Michigan, United States; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D009333:Neck; D000039:Peritonsillar Abscess / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D017703:Retropharyngeal Abscess / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D014481:United States / Q000453:epidemiology
keywords: Deep space neck infection; Healthcare Cost and Utilization Project (HCUP); Kids’ Inpatient Database (KID); Parapharyngeal abscess; Peritonsillar abscess; Retropharyngeal abscess