title: Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology.
abstract: Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children.
  
  
  METHODS
  The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014.
  
  
  RESULTS
  Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified.
  
  
  CONCLUSIONS
  The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.
authors.affiliation: a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.affiliation: b ENT Department , San Giovanni-Addolorata Hospital , Rome , Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Camaioni
authors.affiliation: c Department of Otorhinolaryngology, "San Matteo" Hospital , University of Pavia , Pavia , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Benazzo
authors.affiliation: d Paediatric Haematology-Oncology Department and "Tettamanti" Research Centre , Milano-Bicocca University, "Fondazione Mbbm", San Gerardo Hospital , Monza , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Biondi
authors.affiliation: e ENT Unit, Department of Surgery and Transplantation Centre , Bambino Gesù Children's Hospital, IRCCS , Rome , Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bottero
authors.affiliation: f Epidemiology Unit, Meyer University Hospital , Florence , Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Masi
authors.affiliation: g Primary Care Pediatrician , Caserta , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Mauro
authors.affiliation: h General Paediatrician , Milan , Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Doria
authors.affiliation: i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.affiliation: j Department of Otolaryngology , San Paolo Hospital, University of Milan , Milan , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Felisati
authors.affiliation: j Department of Otolaryngology , San Paolo Hospital, University of Milan , Milan , Italy.
authors.forename: Dino
authors.initials: D
authors.lastname: Felisati
authors.affiliation: k Department of Health Science , University of Florence , Florence , Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Festini
authors.affiliation: l Department of Otorhinolaryngology , San Gerardo Hospital , Monza , Italy.|m Department of Surgery and Translational Medicine , University of Milano-Bicocca , Milan , Italy.
authors.forename: Renato Maria
authors.initials: RM
authors.lastname: Gaini
authors.affiliation: a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.affiliation: n Pathology Unit , Istituto Giannina Gaslini , Genua , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambini
authors.affiliation: o Fondazione Ircss Ca' Granda-Ospedale Maggiore Policlinico , Italy University of Milan , Milan , Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Gianelli
authors.affiliation: p General Paediatrician , Turin , Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Landi
authors.affiliation: q Otolaryngology Unit , Vittorio Veneto Hospital , Vittorio Veneto , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lucioni
authors.affiliation: r ENT Unit , Santo Bono Posillipo Hospital , Naples , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mansi
authors.affiliation: a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy.
authors.forename: Rachele
authors.initials: R
authors.lastname: Mazzantini
authors.affiliation: i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Marchisio
authors.affiliation: s Department of Pediatrics , University of Pavia, Fondazione Irccs Policlinico San Matteo , Pavia , Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Marseglia
authors.affiliation: t Department of Paediatrics , Aldo Moro University of Bari , Bari , Italy.
authors.forename: Vito Leonardo
authors.initials: VL
authors.lastname: Miniello
authors.affiliation: u Department of Molecular Medicine , University of Pavia , Pavia , Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Nicola
authors.affiliation: v Department of Health Sciences, Section of Pharmacology , University of Florence , Florence , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
authors.affiliation: w Department of Pathology, Fondazione Irccs Policlinico San Matteo, and Department of Molecular Medicine , University of Pavia , Pavia , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Paulli
authors.affiliation: x Primary Care Paediatrician , Milan , Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Picca
authors.affiliation: y Oncoemaology Unit, Department of Paediatrics , University of Padua , Padua , Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Pillon
authors.affiliation: z Otorhinolaryngology Unit, Head and Neck Department , San Paolo Hospital, University of Milan , Milan , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pisani
authors.affiliation: aa Department of Cardiovascular Surgery , Ncc Città Di Alessandria Hospital , Alessandria , Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Pipolo
authors.affiliation: i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.affiliation: ab Neuro-Oncology Unit, Meyer Meyer Univeristy Hospital , Florence , Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Sardi
authors.affiliation: ac Otorhinolaryngology Service, Department of Oncology , San Luigi Gonzaga Hospital, University of Turin , Turin , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Succo
authors.affiliation: ad Department of Diagnostic Imaging , Children's Hospital Bambino Gesù , Rome , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tomà
authors.affiliation: ae San Raffaele Institute , Milan , Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Tortoli
authors.affiliation: af University Hospital Pediatric Department , Bambino Gesù Children's Hospital, Rome , Rome , Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Tucci
authors.affiliation: ag San Gennaro Hospital , Naples , Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Varricchio
authors.affiliation: a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
authors.affiliation: ah Florence University , Florence , Italy.
authors.lastname: Italian Guideline Panel For Management Of Cervical Lymphadenopathy In Children
mesh_terms: D000465:Algorithms; D002648:Child; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010036:Otolaryngology / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*
keywords: algorithm; cervical lymphadenopathy; children; evidence based medicine