Acute infectious cervical lymphadenitis—clinical features associated with the need for drainage

Background: Acute infectious cervical lymphadenitis (AICL) is commonly diagnosed in paediatric emergency departments. Early identification of patients likely to require surgical management may facilitate timely intervention and limit the overuse of imaging. This study aimed to identify clinical features associated with the need for surgical drainage in children presenting to tertiary care with AICL. Methods: A single-year retrospective medical chart review was performed at a tertiary paediatric centre in Western Australia. All children presenting to the emergency department with AICL were enrolled. Patients with a history of immunodeficiency, recent neck trauma or non-infectious causes of lymphadenitis were excluded. Demographics, symptomatology, examination findings, blood tests, imaging results and in-hospital management were analysed. Results: Eighty-three patients (mean age 4.4±3.1 years) were included; 49.4% (n=41) were female; 13.3% (n=11) were of Aboriginal or Torres Strait Islander origin; and 21.7% (n=18) were transferred from rural centres. Surgical drainage was required in 31% (n=26) of patients. Evidence of neck-space suppuration on computed tomography was associated with the need for drainage [P=0.043, odds ratio (OR): 8.0, 95% confidence interval (CI): 1.1–56.8]. Drainage was more common in younger patients (2.8 vs. 5.2 years, P