Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Children with a Suspected Deep Neck Space Infection
Child with Suspected Deep Neck Space Infection
Retropharyngeal, Lateral Pharyngeal, Parapharyngeal Abscess
Retropharyngeal, Lateral Pharyngeal, Parapharyngeal Abscess
ED Team Assessment
- History and Physical
- Antibiotic pretreatment may result in more subtle signs and symptoms
- Obtain lateral neck radiograph, NPO
- Tips for Obtaining and Interpreting Lateral Neck Radiographs
Lateral Neck Normal
Lateral Neck Consistent with Possible RPA
Lateral Neck Confirms RPA
Treatment as clinically indicated
Clinical Appearance
Non-Severe Disease
Severe Disease
Concern for airway compromise, sepsis, other complications
- ENT consult and CT not routinely recommended for non-severe disease
- Medical management is successful in most children
- Antibiotic Recommendations
- CBC, CRP
- Admit to inpatient unit
- PICU admission, KOPH consider transfer to PHL
- Antibiotic Recommendations
- CBC, blood culture, BMP, CRP
- Immediate ENT consult
- Urgent CT neck with IV contrast
- PICU, ED review sedation plan
- Airway Response Team as indicated
Evidence
- Retropharyngeal Abscesses: a Clinical and Radiologic Correlation
- Retropharyngeal and Parapharyngeal Infections in Children: The Toronto Experience
- Controversies in the Management of Deep Neck Space Infection in Children: An Evidence-Based Review
- Pediatric Deep Space Neck Infections in U.S Children, 2000–2009
- Deep Neck Infection
- Children with Deep Space Neck Infections: Our Experience with 178 Children