A prospective study of 113 deep neck infections managed using a clinical practice guideline.

OBJECTIVES/HYPOTHESIS: Retropharyngeal abscesses are a difficult to diagnose condition in children. Though some children with such abscesses can be managed with intravenous (IV) antibiotics alone, our group has argued that surgical drainage is the gold standard for safe management and likely leads to shorter hospital stays. We present prospective data on children with retropharyngeal infections who were managed according to a clinical practice guideline that emphasizes reliance on computed tomography and prompt surgical drainage when pus is felt to be present.

STUDY DESIGN: Prospective observational study at a tertiary care children's hospital.

METHODS: Children were included in the study if a retropharyngeal infection was suspected and they were treated according to the clinical guideline between July 2001 and March 2004.

RESULTS: Of 111 children in the study, 73 were ultimately treated with incision and drainage. There was no long-term morbidity or mortality. Surgical patients were more likely to require an intensive care unit (ICU) admission than patients managed with IV antibiotics alone (26.0% vs. 5.3%, P < .01) and on average cost nearly $8,000 more ($22,071 and $14,950; P < .01). However, these results may be biased, as patients requiring surgery were younger, which likely influenced the decision for ICU admission.

CONCLUSIONS: It is possible to treat pediatric retropharyngeal infections according to our clinical guideline with nearly zero long-term morbidity and mortality. Our data showed good outcomes for both groups, and substantially higher costs for patients treated surgically. These results cannot be regarded as definitive, because surgery was consistently advised for all patients with suspected pus, and because the surgical group was younger than the nonsurgical group.