Neck Infection Clinical Pathway — Emergency | Children's Hospital of Philadelphia

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

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

Ill Appearing

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
Admit PICU
Immediate ENT consult
Urgent imaging
- PICU/Critical Airway Team/ED
- Discussion regarding sedation

Inpatient Management

Posted: February 2017
Reviewed: October 2019
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

Evidence

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

©2019 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.