Multivariate approach to investigating prognostic factors in deep neck infections

Abstract

Deep neck infections (DNI) spread along fascial planes and involve neck spaces. Very few studies have investigated potentially prognostic factors using multivariate statistical models. Our aim was to analyze 282 consecutive cases of DNI using multivariate (logistic) statistical models to identify independent significant factors influencing prognosis in terms of complications and long-term hospitalization (>6 days). In our series, only involvement of more than one neck space was independently significant in prognosticating complications of DNI (odds ratio [OR] 2.46). The presence of comorbidities (OR 2.13), non-odontogenic sites of origin (OR 1.88), leukocyte counts above 11.0 cells × 10(9)/L at presentation (OR 3.57), and the need for both medical and surgical treatments (OR 4.66) was significantly and independently prognostic of long hospital stays. Multivariate analysis can distinguish between risk factors and their relative contribution to outcome. The few published studies using multivariate models to analyze DNI prognosis considered quite large cohorts, but no clinical variables persistently revealed an independent significant prognostic role. This evidence seems to underscore the complex interdependence of several clinical variables in contributing to DNI prognosis, and the heterogeneity of the diagnostic/therapeutic approaches adopted.

The Factors Contributing to Efficiency in Surgical Management of Purulent Infections of Deep Neck Spaces

“…Some authors report that the multiple spaces involved in DNI are prognostic factors for increased complication rate, but not for the long-term hospitalization. 16 In our population, we also did not observe significantly longer hospitalization among 8 patients with more than 1 space involved. The precise identification of the inflammatory process cause may be difficult in some cases due to previous antibiotic treatment and delayed occurrence of DNI.…”

“…7,[17][18][19] There is an agreement among authors concerning the increasing rate of unknown primary origin of DNI that stands for 16% to 50% of cases. 6,7,16,17 In our study, the patients with confirmed tooth decay have 43.2% of cases and their hospitalization stay was compared to those with other causes of DNI. On the contrary, Staffieri et al found that DNI with odontogenic origin had significantly shorter hospitalization; however, the complication rate did not differ among study groups.…”

Oropharyngeal and Tonsillar Infections

“…One series review of the literature from 1994 to 2004 found a mortality rate of 6.1 to 41.7% when lifethreatening complications occurred. 35 Acute pharyngitis is becoming a less frequent cause of these complications since the advent of penicillins, while there has been an increase in deep space neck infection of odontogenic origin. 8,35 This emphasizes the need for a thorough evaluation of the dental structures during the history and physical examination.…”

“…35 Acute pharyngitis is becoming a less frequent cause of these complications since the advent of penicillins, while there has been an increase in deep space neck infection of odontogenic origin. 8,35 This emphasizes the need for a thorough evaluation of the dental structures during the history and physical examination. Similarly, patients with complex medical histories such as diabetes or HIV tend to have atypical complications.…”

“…Studies analyzing the complications of a deep neck infection found that the only prognostically significant factor contributing to complications was the involvement of more than one neck space, whereas hospital stays were likely to be increased in patients with medical comorbidities, leukocytosis, and the need for both medical and surgical treatment. 35 The role of the clinician in knowing when to suspect a deep space neck infection cannot be overemphasized. Despite the fact that medical treatments are improving the rates of these complications, they do occur and can have serious sequelae if not diagnosed in a timely manner.…”