Neck Infection — History and Physical Assessment — Clinical Pathway: Emergency

Deep Neck Space Infection Clinical Pathway — Emergency Department

History and Physical Assessment

Children with suspected deep neck space infection present most often with fever and limited ROM of the neck, especially extension, due to pain. Neck mass may or may not be present. There is often history of decreased PO and drooling. Children usually appear moderately ill. Younger infants may have non-specific symptoms such as fever and fussiness. Respiratory distress due to airway obstruction, abscess rupture, or mediastinal extension rarely occurs. Children who have been treated with antibiotics may have more subtle signs and symptoms, evaluation should proceed based on individual clinical decision making.

History
  • Fever duration
  • Limited range of motion/inability to extend neck
  • Drooling
  • Decreased PO intake
  • Recent oral, neck trauma
  • Concern for foreign body
  • Recent head, neck surgery
  • Recent antibiotic course
Physical Assessment
  • General appearance, mental status
  • Fever, VS, perfusion
  • ROM of neck
  • Unwillingness to move neck
  • Dysphagia/odynophagia
  • Cervical lymphadenopathy, mass
  • Lateral neck swelling
  • Drooling, oropharyngeal abnormalities
  • Respiratory distress
    • Tachypnea, stertor, stridor, wheeze
  • Trismus