2015 HSC Section 1 Book of Articles
Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2014; 78(3):423-426.
International
Journal
of Pediatric Otorhinolaryngology 78
(2014)
423–426
Contents
lists
available
at ScienceDirect
International
Journal
of Pediatric Otorhinolaryngology
jour nal
homepage:
www.elsevier .com/locat e/ijpo r l
Benefits pediatric
of
ultrasound
vs.
computed
tomography
in
the
diagnosis
of
abscesses §
lateral
neck
Collins a ,
Stoner b , G.
Paul Digoy a , *
Benjamin
Julie
A.
a Department
of Otorhinolaryngology, University
of Oklahoma Health
Sciences
Center,
P.O.
Box
26901 WP
1290, Oklahoma
City, OK
73126-0901,
United States b Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 800 NE 13th Street, Oklahoma City, OK 73190, United States
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Article
history:
There
are no
studies
comparing
the accuracy of ultrasound lateral neck abscesses. This
and
computed
tomography
in
the
Objective:
Received Received Accepted Available
7
September
2013
case
series assesses
the accuracy
same population of pediatric patients with
in
revised
form
27 November
2013
the
two
imaging
techniques.
of
28 November
2013
One hundred and
forty
imaging
studies
(ultrasound n = 39 or CT n = 101)
that were performed
Methods:
online
7 December
2013
2005
to
2011
prior
to
incision
and
drainage
of
a
lateral
neck mass
at
a
tertiary
care
academic
from
reviewed. All children 0–18 years of age with
lateral neck abscesses who
institution were retrospectively
Keywords: Ultrasound Computed
CT
or
ultrasound
imaging
prior
to
drainage
were
included.
Sensitivity,
specificity,
and
underwent positive standard,
and negative predictive
values of ultrasound
and CT were determined
as
compared
to
the gold
tomography
incision
and
drainage
of
the
suspected
abscess.
neck
abscess
Lateral
In children undergoing
incision and drainage,
the prevalence of an abscess was 89%. Ultrasound
Results:
Pediatrics
specificity
(100%) but a
low sensitivity
(53%). The positive predictive value
(96%)
is high while contrast, CT
has a high
the negative predictive value is
low (16%), assuming a positive abscess prevalence of 0.9. In
low
specificity
(18%)
but
slightly
higher
sensitivity
(68%)
compared
to
ultrasound.
Similar
to
has
CT
had
low
negative
(6%)
and
high
positive
(88%)
predictive
values.
ultrasound, Conclusions:
This
study
demonstrates
that
ultrasound
may
be
an
equivalently
sensitive
and
more
tool when
compared
to CT
in
the work-up undetermined of
lateral neck probability
abscesses
in
children.
It
is
specific diagnostic
and
effective
in
diagnosis when
there
is
an
of
an
abscess.
safe
2013
Elsevier
Ireland
Ltd.
All
rights
reserved.
1. Introduction
the wide variability
in the ages of subjects
included
in this study. A
ultrasound abscesses
study
of
41
surgically
confirmed
retrospective
neck
abscesses
are
increasing
in
incidence
in
the
neck
revealed abscess,
31
true
positive
cases,
6
pediatric reported
Lateral
population
[1] .
Ultrasound
and
computed
tomography
as
probable
for
an
and
4
false negative
results.
pediatric
are
currently
used
to
screen
patients
for
the
presence
or
for an abscess on 4/5 children prior
to a surgically
(CT)
CT was positive
of
a
lateral
neck
abscess. While
there
have
been there
some
abscess
[3] .
The major
limitation
is
that
only
children
absence
confirmed
of
ultrasound
and
CT
in
the
literature,
is
no
included. There were no
evaluations
with abscess confirmed on drainage were
standard recent examination of 36 patients ages 2–62 years undergoing ultrasound prior to attempted drainage of an abscess demonstrated 96% sensitivity and 82% specificity. Positive predictive value was 92% and negative predictive value was 90% [2] . These are promising results, but the application to pediatric neck abscesses is limited by protocol at our institution and many others. A
positives
or
true
negatives
to
report.
These
patients otogenic,
had and
false
variable
pathology
including following
odontogenic,
widely
sources,
one
an
insect
bite,
and
another sources
tonsillogenic
tuberculosis.
The majority
of
infectious
associated with
study
showed
a
relatively
low
were unknown. Another pediatric
of
ultrasound
(65%)
but
a
high
specificity predictive
(88%), value
a
sensitivity
predictive
value
of
81%,
a
negative
of
positive
and
concluded alongside
that
a
clinical
evaluation ultrasound
is
integral
in
the
77%,
the
use
of
[4] .
The
specific
diagnosis
§ Presented
at
2013
Triological
Society
Combined
Sections Meeting,
Scottsdale,
the neck masses were not provided. The
sensitivities
locations of
States,
January
26,
2013.
AZ, United
* Corresponding
specificities
in
these
three
ultrasound
studies
were
not
and
author
at:
Oklahoma
University
Health
Sciences,
Center
Department
of
ORL,
P.O.
Box
26901 WP
1290,
Oklahoma
City,
OK
73126-0901,
to
those
of
CT.
comparable
States.
Tel.:
+1
405
271
8001x47900;
fax:
+1
405
271
3248.
United
a
study been
of 38
children
and
adults with deep neck
infections,
In
benjamin-collins@ouhsc.edu
(B.
Collins),
addresses:
has
shown
to
have
a
sensitivity
of
88%
in
diagnosing
an
CT
(J.A.
Stoner),
paul-digoy@ouhsc.edu
(G.P. Digoy).
julie-stoner@ouhsc.edu
0165-5876/$
–
see
front matter
2013
Elsevier
Ireland
Ltd. All
rights
reserved.
http://dx.doi.org/10.1016/j.ijporl.2013.11.034
216
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