Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with a Suspected Deep Neck Space Infection
Signs/Symptoms Often Associated with Deep Neck Space Infection
(Retropharyngeal, Lateral pharyngeal, and Parapharyngeal abscess)
(Retropharyngeal, Lateral pharyngeal, and Parapharyngeal abscess)
Critically Ill
- Refer to pathways
- Sepsis, ED, Inpatient, PICU
- Airway, Difficult/Critical
Children who have been pretreated with antibiotics may have more subtle signs and symptoms
Obtain Lateral Neck Film
Tips for Interpreting Lateral Neck Films
Tips for Interpreting Lateral Neck Films
Negative Lateral Neck
Low Clinical Suspicion
Low Clinical Suspicion
Equivocal Lateral Neck or
Significant Clinical Suspicion
Significant Clinical Suspicion
Positive Lateral Neck
ED attending may consider neck CT
as clinically indicated
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
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
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
- 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