A clinical decision rule for the use of ultrasound in children presenting with acute inflammatory neck masses

Golriz, Farahnaz; Bisset, George S.; D’Amico, Beth; Cruz, Andrea T.; Alade, Kiyetta; Zhang, Wei; Donnelly, Lane F.

doi:10.1007/s00247-016-3774-9

Cited by 8 publications

(10 citation statements)

References 17 publications

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“…In a tertiary care setting such as our institution, children with suppurated cervical lymphadenitis are seen after first‐line antibiotic treatment usually performed at home so that, after admission, they are promptly submitted to ultrasonography, needle aspiration for both diagnosis and treatment, with ultrasonography guidance depending on the depth of the node involved, and intravenous second‐line antibiotic treatment is started. We were able to identify causative organism in 62% of cases, which is within the range reported in the literature (36%‐87%) . If there is suppuration recurrence, we perform more needle aspirations.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients

Grazioli

Bazzana

Berlucchi

et al. 2018

Clinical Otolaryngology

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Section: Discussionmentioning

confidence: 99%

Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients

Grazioli

Bazzana

Berlucchi

et al. 2018

Clinical Otolaryngology

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“…For instance, clinicians may pursue early imaging in children who present with longer duration of symptoms or more severe illness on presentation, as these fac- tors may be associated with abscess formation. 1,6,7 These clinical covariates are not available in PHIS. Thus, we used prior ED visits for lymphadenitis to approximate illness duration, and initial admission to ICU, receipt of IV analgesia, and receipt of broad-spectrum antibiotics to approximate illness severity in an attempt to mitigate confounding.…”

Section: Discussionmentioning

confidence: 99%

“…Confounding may be one explanation for this finding. For instance, clinicians may pursue early imaging in children who present with longer duration of symptoms or more severe illness on presentation, as these factors may be associated with abscess formation 1,6,7 . These clinical covariates are not available in PHIS.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, routinely conducting imaging on presentation may constitute overuse, as children with cervical lymphadenitis who present with less than 72 hours of neck swelling rarely undergo surgical drainage within the first 24 hours of hospitalization. 1,6,7 Imaging performed on presentation is often repeated later during hospitalization, particularly if the patient has not improved with antibiotic therapy. The net result may be unnecessary, redundant radiologic studies.…”

mentioning

confidence: 99%

“…As demonstrated for several other common pediatric conditions, 4,5 variability in imaging practices may contribute to overutilization of resources in children with cervical lymphadenitis. In particular, routinely conducting imaging on presentation may constitute overuse, as children with cervical lymphadenitis who present with less than 72 hours of neck swelling rarely undergo surgical drainage within the first 24 hours of hospitalization 1,6,7 . Imaging performed on presentation is often repeated later during hospitalization, particularly if the patient has not improved with antibiotic therapy.…”

mentioning

confidence: 99%

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Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Desai

Shah

Hall

et al. 2019

Journal of Hospital Medicine

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OBJECTIVES: This study aimed to describe variation in imaging practices and examine the association between early imaging and outcomes in children hospitalized with cervical lymphadenitis. METHODS: This multicenter cross-sectional study included children between two months and 18 years hospitalized with cervical lymphadenitis between 2013 and 2017. Children with complex chronic conditions, transferred from another institution, and with prior hospitalizations for lymphadenitis were excluded. To examine hospital-level variation, we calculated the proportion of children at each hospital who received any imaging study, early imaging (conducted on day 0 of hospitalization), multiple imaging studies, and CT imaging. Generalized linear or logistic mixed effects models examined the association between early imaging and outcomes (ie, multiple imaging studies, surgical drainage, 30-day readmission, and length of stay) while accounting for patient demographics, markers of illness duration and severity, and clustering by hospital. RESULTS: Among 10,014 children with cervical lymphadenitis, 61% received early imaging. There was hospital-level variation in imaging practices. Compared with children who did not receive early imaging, children who received early imaging presented increased odds of having multiple imaging studies (adjusted odds ratio [aOR] 3.0; 95% CI: 2.6-3.6), surgical drainage (aOR 1.3, 95%CI: 1.1-1.4), and 30-day readmission for lymphadenitis (aOR 1.5, 95%CI: 1.2-1.9), as well as longer lengths of stay (adjusted rate ratio 1.2, 95%CI: 1.1-1.2). CONCLUSIONS: Children receiving early imaging had more resource utilization and intervention than those without early imaging. Our findings may represent a cascade effect, in which routinely conducted early imaging prompts clinicians to pursue additional testing and interventions in this population.

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Sensitivity and Specificity of US and CT as Diagnostic Tools for Pediatric Lateral Neck Abscesses

Ramazani

Yunker

Liu

2023

Otolaryngol.--head neck surg.

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Objective. Ultrasound (US) and computed tomography (CT) are commonly used in the diagnosis of pediatric neck abscesses. The objective of this study is to determine the sensitivity and specificity of US and CT in the diagnosis of pediatric lateral neck abscesses, with a secondary objective of evaluating the association of specific clinical features with a positive US or CT scan.Study Design. Retrospective review of pediatric patients admitted to a tertiary care center from January 1, 2011, to December 31, 2020, with neck abscesses.Setting. Tertiary care center.Methods. The sensitivity and specificity of US and CT were calculated by comparing imaging performed within 24 h of incision and drainage (I&D). Multiple regression was used to evaluate the association of clinical features with a true positive US or CT.Results. There were 171 patients included in this study, with a median age of 1.5 years (interquartile range [IQR]: 1-5 years). I&D was done in 156 patients (91.2%), while 15 (8.8%) were treated with antibiotics. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US were 69.5%, 80%, 96.6%, and 24.2%. The sensitivity, specificity, PPV, and NPV of neck CT were 95.5%, 80%, 95.5%, and 57.1%. Length of symptoms, skin erythema, and fluctuance were not significantly associated with a positive US (F(3, 82) = 0.24, p = .9, R 2 = 0.01) or CT scan (F(3, 30) = 0.84, p = .5, R 2 = 0.08). Conclusion.Neck US has a low sensitivity for diagnosing pediatric neck abscesses, when compared to CT, but remains a useful initial investigation given its high PPV. Clinicians should have a low threshold for pursuing CT if there is a high suspicion of abscess formation. Level of Evidence: Level 4.

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A clinical decision rule for the use of ultrasound in children presenting with acute inflammatory neck masses

Abstract: Children older than 1 year with inflammatory neck swelling ≤3 days are at low risk of having ultrasound findings that require drainage. In this subgroup of patients, ultrasound could be avoided unless the patient fails to improve after a trial of antibiotic therapy.

Cited by 8 publications

References 17 publications

Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients

Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Sensitivity and Specificity of US and CT as Diagnostic Tools for Pediatric Lateral Neck Abscesses

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