Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with a Suspected Deep Neck Space Infection

Goals and Metrics
Signs/Symptoms Often Associated with Deep Neck Space Infection
(Retropharyngeal, Lateral pharyngeal, and Parapharyngeal abscess)
Exclusions
Triage
History and Physical Assessment
Critically Ill
Children who have been pretreated with antibiotics may have more subtle signs and symptoms
Obtain Lateral Neck Film
Tips for Interpreting Lateral Neck Films
Negative Lateral Neck
Low Clinical Suspicion
Equivocal Lateral Neck or
Significant Clinical Suspicion
Positive Lateral Neck
ED attending may consider neck CT
as clinically indicated
Treatment as clinically indicated
Clinical Appearance
Non-toxic (Non-Severe)
Ill Appearing (Severe)
  • IV Antibiotics
  • CBC, blood culture, CRP
  • Admit to inpatient unit
  • Consider ENT consult after admission if clinically indicated
  • IV Antibiotics
  • CBC, blood culture, BMP, CRP
  • Consider admit to PICU
  • Immediate ENT consult
  • Urgent imaging
    • PICU/Critical Airway Team/ED
    • Discussion regarding sedation
Inpatient Management
Posted: February 2017
Revised: September 2022
Authors: R. Abaya, MD; M. Joffe, MD; L. Vella, MD; M. Dunn, MD; S. MacFarland, MD; M. Rizzi, MD; K. Shekdar, MD; R. Bellah, MD; J. Lavelle, MD; E. Kitt, MD; E. Delgado, MD; K. Chiotos, MD; V. Kampalath, MD; T. Metjian, PharmD