Pediatric deep space neck infections in U.S. children, 2000–2009 Sarah J. Novis a, *, Cedric V. Pritchett a,1 , Marc C. Thorne a,2 , Gordon H. Sun a,b,c,3 a Department of Otolaryngology – Head and Neck Surgery, University of Michigan, United States b Robert Wood Johnson Foundation Clinical Scholars, University of Michigan, United States c VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States 1. Introduction Deep space neck infections (DNI) are a significant clinical entity in the pediatric population, commonly affecting the retropharyngeal, parapharyngeal, or peritonsillar spaces [1]. While most pediatric DNI respond to intravenous antibiotics and surgical incision and drainage, rare cases can lead to life- threatening complications. Pediatric DNI have been associated with mediastinitis, jugular vein thrombosis, and airway obstruc- tion [2,3]. There has been concern that the incidence of DNI in children is increasing [4–6]. Widespread use of antibiotics in the primary care setting has contributed to an increase in drug-resistant bacterial strains in normal oropharyngeal flora. Methicillin-resistant Staph- ylococcus aureus (MRSA) is becoming a more common organism isolated from head and neck aspirates [7–13]. Although it has been demonstrated that the nature of pediatric DNI is changing, there has not been a study at the national level to International Journal of Pediatric Otorhinolaryngology 78 (2014) 832–836 ARTICLE INFO Article history: Received 25 October 2013 Received in revised form 8 February 2014 Accepted 17 February 2014 Available online 26 February 2014 Keywords: Deep space neck infection Peritonsillar abscess Parapharyngeal abscess Retropharyngeal abscess Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) ABSTRACT Objective: Deep space neck infections (DNI) are common pediatric illnesses, which can lead to significant morbidity and healthcare expenditures. Recent studies suggest that the incidence of pediatric DNI in the United States is increasing, but no nationally representative studies exist. This study sought to characterize pediatric DNI at the national level over the past decade and to determine whether U.S. incidence of pediatric DNI and associated resource utilization changed from 2000 to 2009. Methods: The Kids’ Inpatient Database (KID) was used to evaluate pediatric DNI incidence, demographics, and outcomes from 2000 to 2009. Cases were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes for peritonsillar abscess (475), parapharyngeal abscess (478.22), and retropharyngeal abscess (478.24). Regression analyses within each year and across the entire study period were performed on variables of interest including performance of imaging studies, operative intervention, length of hospital stay and total hospital charges. Results: The incidence of retropharyngeal abscess increased significantly from 0.10 cases per 10,000 in 2000 to 0.22 in 2009 (p = 0.02). There was no significant change during this time period in the incidence of combined DNI (1.07–1.37 cases per 10,000, p = 0.07), peritonsillar abscess (0.82–0.94 cases per 10,000, p = 0.12) or parapharyngeal abscess (0.08–0.14 cases per 10,000, p = 0.13). The percentage of retropharyngeal abscess patients managed surgically decreased (48–38%, p = 0.04) and the average length of hospital stay also decreased during this time (4.6–3.9 days, p = 0.03). There was a marked increase in the total inflation-corrected hospital charges per case for all DNI ($9,486–16,348, p = 0.005). Conclusions: The incidence of pediatric retropharyngeal abscess has increased significantly from 2000 to 2009, without concurrent increases in the incidence of combined DNI, peritonsillar, or parapharyngeal abscesses. There has been a change in management of retropharyngeal abscesses during this time with a decrease in operative intervention and a decrease in the length of hospital stay. Hospital charges associated with all pediatric DNI have nearly doubled during this timeframe, warranting future epidemiologic resource utilization studies in this population. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Taubman Center 1904, 1500 East Medical Center Drive, SPC 5312, Ann Arbor, MI 48109, United States. Tel.: +1 734 936 9178; fax: +1 734 936 8052. E-mail address: sarahnov@med.umich.edu (S.J. Novis). 1 Taubman Center 1904, 1500 East Medical Center Drive, SPC 5312, Ann Arbor, MI 48109, United States. Tel.: +1 734 936 9178; fax: +1 734 936 8052. 2 C.S. Mott Children’s Hospital, 1540 East Hospital Drive, SPC 4241, Ann Arbor, MI 48109-4241, United States. Tel.: +1 734 936 4934; fax: +1 734 763 7802. 3 280 South Beverly Drive, Suite 404, Beverly Hills, CA 90212, United States. Tel.: +1 310 858 9555; fax: +1 310 858 9552. Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl http://dx.doi.org/10.1016/j.ijporl.2014.02.024 0165-5876/ß 2014 Elsevier Ireland Ltd. All rights reserved.