2015 HSC Section 1 Book of Articles
B.
Collins
et al.
/ International
Journal
of Pediatric Otorhinolaryngology 78
(2014)
423–426
5. Conclusion
situations
as
well,
but
only
after
reasonable
justification
and
of
side
effects
to
the
child.
consideration
the drawbacks
to the use of bedside ultrasound
The sensitivity of ultrasound and CT in
the diagnosis of pediatric
Currently one of
its availability. At
this
institution, an ultrasound
technician
neck
abscesses
is
similar,
yet
ultrasound
may
be
more
may be
lateral
not
be
consistently
available
overnight
or of
on
the weekend
compared
to
the
outcome
of
attempted
drainage.
may
specific when
this
is
changing.
The
availability
ultrasound
may
The use of an ultrasound in
the diagnosis of a
lateral neck abscess
in
although improve
as
its
demand
increases
across
all to
fields
of medicine.
To
a child may provide
similar
information
to
the
clinician at
a
lower
it may be necessary
specify
the need
for an
lower
risk
to
the
child
compared
to CT. As
such,
it may be
improve availability,
cost and preferred ultrasound
technician
during
extended
periods.
It
also
may
be to so
for
diagnosis
in
many
situations.
We
propose
that
ultrasound beneficial
for
more
physicians performing
including
otolaryngologists
should
be
considered
prior
to
requesting
a
CT
scan.
proficient
in
and
interpreting
ultrasound
become
disclosure
information
Financial
that it may be used whenever children present with symptoms of a serious abscess. The decision to perform an ultrasound was based on clinician preference and availability of ultrasound technicians in this study. In the absence of a truly randomized study, some selection bias may exist. It may not be ethical to perform a randomized controlled trial in the interest of cost and potential harm to the child from a CT. The reported data are based on patients who underwent a diagnostic screening test, CT and/or ultrasound, and the gold standard test, drainage of the abscess. There is potential for verification bias because not all patients who underwent an initial screening test also underwent the definitive gold standard test. Many of our patients with cervical adenitis and a suspected abscess will resolve clinically without undergoing incision and drainage. Also, not all childrenwho underwent the gold standard at this institution underwent an imaging study prior to incision and drainage. These two groups were not evaluated in this study. As previous studies recognize, ultrasound interpretation is operator dependent [2] . Computed tomography is subject to variations in operation and interpretation as well [12] . Therefore, the ability to reproduce the results of this study may be affected by the specialty and level of expertise of the examiner. In the absence of otolaryngologists who are comfortable interpreting ultrasound, studies examining its use in the field may continue to be limited by this factor. Another limitation of this study is the small number of subjects with pus-negative abscesses ( n = 16). This decreased the precision of our estimate of the specificity for both ultrasound and CT. Without needlessly imaging patients who have a low probability of an abscess, these numbers are unlikely to increase. Expanding the enrollment through a future multicenter study may address this limitation. It is also important to note that the positive and negative predictive values are influenced by the assumed true prevalence of abscess positivity in the population. We expect the positive predictive value to be high and the negative predictive value to be low in settings with a high prevalence, such as tertiary care centers similar to ours.
financial
or material
support
for
this
research
to
disclose.
No
authors have
no financial
interest
in
companies
or
entities
to
The
disclose.
of
interest
Conflict
interest
to disclose, financial or
The authors have no conflicts of
otherwise.
References
[1]
C.E.
Cabrera,
E.S.
Deutsch,
S.
Eppes,
S.
Lawless,
S.
Cook,
R.C.
O’Reilly,
et
al.,
incidence
of
head
and
neck
abscesses
in
children,
Otolaryngol.
Head
Increased
Surg.
136
(2007)
176–181.
Neck
C.N.J. Mallorie, S.D.
Jones, N.A. Drage, identification of pus
J. Shepherd, The
reliability of high
resolution
[2]
in
the
collections
in head and neck
swellings,
Int.
ultrasound
Surg.
41
(2012)
252–255.
J. Oral Maxillofac.
S.
Ku¨hnemann,
T.
Keck,
H.
Riechelmann,
G.
Rettinger,
Rational
diagnosis
of
[3]
pharyngeal
abscess,
Laryngorhinootologie
80
(2001)
263–268.
pediatric
S.
Douglas,
S.
Jennings,
V.
Owen,
S.
Elliott,
D.
Parker,
Is
ultrasound Otolaryngol.
useful
for
[4]
paediatric
inflammatory
neck masses?
Clin.
30
(2005)
evaluating 526–529.
J.B.
Lazor,
M.J.
Cunningham,
R.D.
Eavy,
A.L. Weber,
Comparison
of
computed
[5]
in deep neck
infections, Otolaryngol. Head Neck
tomography and surgical findings
111
(1994)
746–750.
Surg.
K.
Ungkanont,
R.F.
Yellon,
J.L. Weissman, M.L.
Casselbrant,
H.
Gonza´lez-Valde-
[6]
C.D.
Bluestone,
Head
and
neck
space
infections
in
infants
and
children,
pen˜a,
Surg.
112
(1995)
375–382.
Otolaryngol. Head Neck
[7] American Medical Association, Current Procedural
Terminology 2010,
American
Association,
Chicago,
2010.
Medical
A.J.
Einstein, M.J. Henzlova,
S.
Rajagopalan,
Estimating
risk
of
cancer
associated
[8]
radiation
exposure
from
64-slice (2007)
computed
tomography
coronary
angiog-
with
J.
Am. Med.
Assoc.
298
317–323.
raphy,
D.J. Brenner,
Should we be
concerned
about
the
rapid
increase
in CT usage? Rev.
[9]
25
(2010)
63–68.
Environ. Health
D.
Brenner,
C.
Elliston,
E. Hall, W.
Berdon,
Estimated
risks
of
radiation-induced
[10]
cancer
from
pediatric
CT,
Am.
J.
Roentgenol.
176
(2001)
289–296.
fatal
M.S. Pearce,
J.A. Salotti, M.P.
Little, K. McHugh, C.
Lee, C. Pyo Kim, et al., Radiation
[11]
from CT
scans
in
childhood
and
subsequent
risk of
leukemia
and brain
exposure tumours:
a
retrospective
cohort
study,
Lancet
380
(2012)
499–505.
M.
Rosenthal,
D.
Oreadi,
J.
Kraus,
H.
Bedi,
P.C.
Stark,
K.
Shastri,
Comparison
of
[12]
computed
tomography
and
surgical findings
in maxillofacial
infec-
preoperative
J. Oral Maxillofac.
Surg.
69
(2011)
1651–1656.
tions,
219
Made with FlippingBook