Deep Neck Space Infection Clinical Pathway — Emergency Department

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

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
Last Revised: October 2024
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

Evidence

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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.

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

Evidence

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