title: Suggested Protocol for Managing Acute Suppurative Cervical Lymphadenitis in Children to Reduce Unnecessary Surgical Interventions.
abstract: OBJECTIVE
  The indications and benefits of surgery in the management of pediatric acute suppurative cervical lymphadenitis (ASCL) remain unclear. We aimed to design a management protocol focusing on the avoidance of unnecessary operation in pediatric ASCL patients.
  
  
  METHODS
  The study population consisted of 45 pediatric patients with ASCL treated with antibiotics alone and 30 surgically treated patients. The primary outcome was the determination of differences in patient characteristics and radiologic findings in the 2 groups. The secondary outcome, after matching 20 cases with 20 controls, was to determine the benefits of surgery to patients.
  
  
  RESULTS
  There were no significant differences between the 2 groups in patient characteristics and radiologic findings at initial presentation. In the matched case-control analysis, intravenous antibiotics alone yielded successful treatment outcomes when compared with surgery, with no significant differences in time to symptom resolution, normalized laboratory test results, and duration of hospitalization (all P > .05).
  
  
  CONCLUSIONS
  The size and location of suppurated lymph nodes are not absolute determinants for surgical drainage in the stable pediatric ASCL patients. If patients show no clinical improvements despite appropriate second- and third-line antibiotics, patients should be carefully reevaluated and image-guided aspiration considered.
authors.affiliation: Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
authors.forename: Minsu
authors.initials: M
authors.lastname: Kwon
authors.affiliation: Departments of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro Jinju, Republic of Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Ki Ju
authors.initials: KJ
authors.lastname: Cho
authors.affiliation: Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Seong Jun
authors.initials: SJ
authors.lastname: Won
authors.affiliation: Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Seung Hoon
authors.initials: SH
authors.lastname: Woo
authors.affiliation: Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Jin Pyeong
authors.initials: JP
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea capetown@hanmail.net.
authors.forename: Jung Je
authors.initials: JJ
authors.lastname: Park
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D061605:Administration, Intravenous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D019468:Disease Management; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery*; D008199:Lymphadenitis / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D009333:Neck; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents
keywords: abscess; cervical lymphadenitis; children; lymph node; surgery