Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Abstract

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.

Benign lymphoepithelial cyst of parotid gland without human immunodeficiency virus infection: A case report

“…Histological examination of the mass case showed that the cyst wall was laminated squamous epithelium without epithelial nail process and the surface layer was mostly incomplete keratosis, surrounded by a large number of lymphoid stromata with lymphoid follicular formation and a center of occurrence. Differential diagnoses include: (1) Warthin tumor[ 2 ], which is more common in middle-aged and elderly patients and more likely to occur in the posterior lower pole of the parotid gland, with uneven internal density; (2) Intramuscular benign hemangioma[ 13 ], which is a fast-flowing intramuscular mass with uneven density and visible fat density in children that requires pathological examination for diagnosis; (3) Lymphoma[ 14 ], which is more common in men over 50 years old and appears as irregular soft tissue masses with a large range and uniform density on CT, without obvious calcification, cystic degeneration or necrosis, with diffuse growth to the surrounding area and mostly without adjacent bone destruction, and mild to moderate enhancement on enhanced scanning; (4) Thyroglossal duct cysts[ 15 ], which present as a painless mass in the front of the neck and are usually dumbbell shaped and movable when the tongue is extended or swallowed; CT shows a low-density, usually monocular parenchyma lesion during embryonic thyroid migration, mostly located in the midline and associated with the hyoid bone; (5) Lymphocele[ 16 ], which typically manifest as a cystic density focus with uniform density, clear boundary, thin cyst wall, no obvious exudation and calcification, and after enhancement, the cyst wall can present slightly uniform enhancement, with no enhancement in the cyst; (6) Metastatic lymph nodes[ 17 ], which are accompanied by a history of primary tumor, and on CT exhibit uneven density, calcification, cystic or necrotizing changes, uneven edges, adhesion to surrounding tissues, and obvious annular or peripheral enhancement; and (7) Lymphadenitis[ 18 ], which is more common in children and present with local redness, swelling, heat and pain while appearing mostly oval with a thick wall and ring and uniform enhancement without obvious wall nodules and calcification, but with a blurred surrounding fat space. The current treatment principles for this disease include early diagnosis, infection control, and cyst removal, and the treatment options include observation, repeated aspiration, sclerotherapy, radiotherapy, and surgical treatment[ 4 ].…”

Factors Associated With Inpatient Subspecialty Consultation Patterns Among Pediatric Hospitalists

“…To allow for comparison of consultation use across patients and across physicians, we targeted well-defined cohorts of general pediatrics patients. Using identifiable International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10)-based criteria used in large studies of hospitalized children (eTable 2 in Supplement 1), [23][24][25][26][27][28][29] we included hospitalizations for any of the following 15 common pediatric conditions: asthma, bronchiolitis, cervical lymphadenitis, constipation, croup, deep neck space infection, febrile infant, gastroenteritis, Kawasaki disease, orbital or preseptal cellulitis, osteomyelitis, pneumonia, septic arthritis, skin and soft-tissue infection (SSTI), and urinary tract infection (UTI). For the small proportion (2%) of hospitalizations that met definitions for 2 conditions, we applied consensus criteria (eTable 3 in Supplement 1) or, if criteria could not be applied, 2-physician review to assign the condition expected to primarily inform consultation practices.…”

Opportunities for Stewardship in the Transition From Intravenous to Enteral Antibiotics in Hospitalized Pediatric Patients

“…The diagnosis cohorts were defined based on ICD-10-CM discharge diagnoses adapted from previous studies (Appendix Table 1). 3,[17][18][19][20][21][22][23] To define a cohort of generally healthy pediatric patients with an acute infection, we excluded patients hospitalized in the intensive care unit, patients with nonhome discharges, and patients with complex chronic conditions. 24 We also excluded hospitals with incomplete data during the study period (n=1).…”