A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

Abstract

Background: Deep neck infection (DNI) is a serious infectious disease, and descending mediastinitis is a fatal infection of the mediastinum. However, no study has applied artificial intelligence to assess progression to descending mediastinitis in DNI patients. Thus, we developed a model to assess the possible progression of DNI to descending mediastinitis. Methods: Between August 2017 and December 2022, 380 patients with DNI were enrolled; 75% of patients (n = 285) were assigned to the training group for validation, whereas the remaining 25% (n = 95) were assigned to the test group to determine the accuracy. The patients’ clinical and computed tomography (CT) parameters were analyzed via the k-nearest neighbor method. The predicted and actual progression of DNI patients to descending mediastinitis were compared. Results: In the training and test groups, there was no statistical significance (all p > 0.05) noted at clinical variables (age, gender, chief complaint period, white blood cells, C-reactive protein, diabetes mellitus, and blood sugar), deep neck space (parapharyngeal, submandibular, retropharyngeal, and multiple spaces involved, ≥3), tracheostomy performance, imaging parameters (maximum diameter of abscess and nearest distance from abscess to level of sternum notch), or progression to mediastinitis. The model had a predictive accuracy of 82.11% (78/95 patients), with sensitivity and specificity of 41.67% and 87.95%, respectively. Conclusions: Our model can assess the progression of DNI to descending mediastinitis depending on clinical and imaging parameters. It can be used to identify DNI patients who will benefit from prompt treatment.