COVID‐19 pandemic—Impact on deep neck space infections: A retrospective cohort study

Abstract

A deep neck space infection (DNSI) is a serious condition with significant morbidity, mortality, and cost burden to the National Health Service (NHS). The most common causes are dental and tonsillar infections which progress to inflammation or abscess formation in the deep neck spaces. Antimicrobials, surgical drainage of abscesses and supportive treatment are the mainstay of management.The airway is often compromised and requires securing with endotracheal intubation or tracheostomy. The incidence and severity of DNSI reduced significantly in the era of readily available antibiotics, partly due to prompt treatment of predisposing infections.In response to the COVID-19 pandemic, the United Kingdom (UK) went into lockdown on 26th March 2020, with varying restrictions over time, thereafter, partly depending on geographical location. People responded to the pandemic by avoiding presentation to hospitals and primary care. 1 There has also been reduced capacity for face-to-face primary care consultation and examination, especially for upper respiratory tract symptoms such as a sore throat and changes in the hospital management and allocation of hospital resources, particularly intensive care capacity and availability. 2 Several studies have evaluated the impact of the COVID-19 pandemic on upper respiratory tract, pharyngeal and orofacial/ cervicofacial infections, including DNSIs, [3][4][5][6] but none have focused specifically on DNSIs, or evaluated a UK setting. The pandemic's impact on management of DNSIs has yet to be evaluated-a particularly pertinent point given the frequent requirement for airway management in the context of concern around intensive care capacity and aerosol-generating procedures. | ObjectivesWe aimed to understand the impact of the COVID-19 pandemic on the presentation, outcomes, and management of DNSIs. We hypothesised that patients were more likely to present later with more advanced/severe disease for the reasons discussed above. Due to the scarcity of intensive care beds, 2 we postulated that patients requiring airway management were more likely to have tracheostomy performed as this negates the mandatory intensive care admission associated with endotracheal intubation. We also wanted to understand the potential drivers for changes in patient outcomes and management during the COVID-19 pandemic. | METHODSThis manuscript was prepared using the STROBE checklist for cohort studies. 7 Neither ethical approval nor participant consent were required due to the retrospective nature and anonymous handling and reporting of data. | Study designRetrospective cohort study comparing patients with DNSI presenting during the COVID-19 pandemic with those presenting beforehand. | SettingPatients presenting to the ear, nose, and throat (ENT) department of an NHS teaching hospital in the UK during the period 1st April 2019-31st March 2020 (pre-COVID-19 pandemic cohort) and 1st April 2020-31st March 2021 (COVID-19 pandemic cohort). Data was collected retrospectively, from April 2021 to August 2021. | Participa...