title: Evaluation of an imaging protocol using ultrasound as the primary diagnostic modality in pediatric patients with superficial soft tissue infections of the face and neck.
abstract: OBJECTIVE
  To determine the clinical impact of an initiative to use ultrasound (US) as the primary diagnostic modality for children with superficial face and neck infections versus use of computed tomography (CT).
  
  
  METHODS
  Children with a diagnosis of lymphadenitis, face or neck abscess, or face and neck cellulitis were retrospectively evaluated by the otolaryngology service. Patients were separated into two groups based on implementation of a departmental initiative to use US as the primary diagnostic modality. The pre-implementation cohort consisted of patients treated prior to the initiative (2006-2009) and the current protocol cohort consisted of patients treated after the initiative was started (2010-2013). Demographics, use of US or CT, necessity of surgical intervention, and failure of medical management were compared.
  
  
  RESULTS
  Three hundred seventy three children were evaluated; 114 patients were included in the pre-implementation cohort and 259 patients were included in the current protocol cohort for comparison. Patients presenting during the current protocol period were more likely to undergo US (pre-implementation vs. current protocol, p-value) (12% vs. 49%, p < 0.0001) and less likely to undergo CT (66% vs. 41%, p < 0.0001) for their initial evaluation. There were no differences in the percentage of children who underwent prompt surgical drainage, prompt discharge without surgery, or trial inpatient observation. There were also no differences in the rate of treatment failure for patients undergoing prompt surgery or prompt discharge on antibiotics. For those patients who underwent repeat evaluation following trial medical management, US was used more frequently in the current protocol period (4% vs. 20%, p = 0.002) with no difference in CT use, selected treatment strategy, or treatment failure rates.
  
  
  CONCLUSIONS
  Increased use of US on initial evaluation of children with superficial face and neck infections resulted in decreased CT utilization, without negatively impacting outcome. Decreasing pediatric radiation exposure and potential long-term effects is of primary importance.
authors.affiliation: College of Medicine, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA.
authors.forename: Rishabh
authors.initials: R
authors.lastname: Sethia
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Mahida
authors.affiliation: College of Medicine, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Subbarayan
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Department of Otolaryngology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave., Columbus, OH 43210, USA; Department of Pediatric Otolaryngology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address: charles.elmaraghy@nationwidechildrens.org.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Elmaraghy
authors.affiliation: Department of Otolaryngology, The Ohio State University Wexner Medical Center, 410 W. 10th Ave., Columbus, OH 43210, USA.
authors.forename: Garth F
authors.initials: GF
authors.lastname: Essig
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005145:Face / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008199:Lymphadenitis / Q000000981:diagnostic imaging; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents
keywords: CT; Radiation; Superficial neck infection; Ultrasound