Retropharyngeal and Parapharyngeal Abscesses Among Children and Adolescents in the United States: Epidemiology and Management Trends, 2003–2012

• Published in: Journal of the Pediatric Infectious Diseases Society Vol. 5; no. 3; pp. 259 - 268
• Main Authors: Woods, Charles R., Cash, Elizabeth D., Smith, Aaron M., Smith, Michael J., Myers, John A., Espinosa, Claudia M., Chandran, Swapna K.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2016
• Subjects: Adolescent; Child; Child, Preschool; Female; Hospital Charges; Hospitalization; Humans; Incidence; Infant; Length of Stay; Male; Pharyngeal Diseases - epidemiology; Retropharyngeal Abscess - epidemiology; Retropharyngeal Abscess - therapy; Retrospective Studies; United States - epidemiology; retropharyngeal abscess; parapharyngeal abscess; Kids’ Inpatient Database
• ISSN: 2048-7193; 2048-7207
• DOI: 10.1093/jpids/piv010

Introduction
The epidemiology and hospital course of children with retropharyngeal abscess (RPA) or parapharyngeal abscess (PPA) have not been fully described at the national level in the United States.
Methods
Pediatric discharges for PPA and RPA were evaluated by using the Kids' Inpatient Database from 2003, 2006, 2009, and 2012. Cases were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes 478.22 and 478.24 for PPA and RPA, respectively. Nationally representative incidence data were calculated by using weighted case estimates and US census data. Demographic and cost analyses were conducted by using unweighted analyses.
Results
There were 2685 hospital discharges for PPA and 6233 hospital discharges for RPA during the 4 study years combined. The incidence of RPA increased from 2.98 per 100 000 population among children <20 years old in 2003 to 4.10 per 100 000 in 2012. The incidence of PPA peaked at 1.49 per 100 000 in 2006. Incidences were highest among children <5 years old and boys in all age groups for PPA and RPA. Winter-to-spring seasonality also was evident for both. PPA was managed surgically in 58.1% of the cases, and RPA was managed surgically in 46.7%. Surgery was performed most often on the day of admission or the following day, was more frequent at teaching hospitals, and was associated with higher hospital charges. The mean hospital length of stay was longer for children who had surgery versus those who did not (4.4 vs 3.1 days [for PPA] and 4.8 vs 3.2 days [for RPA], respectively; both P < .001). The median charges for RPA and PPA were similar. The proportions of children with RPA or PPA covered by Medicaid increased during the study period.
Conclusion
PPA and RPA represent relatively common male-predominant childhood infections with similar epidemiologies. The incidence of hospital discharges with a diagnosis of RPA increased during the study period. Substantial proportions of children with PPA or RPA are now managed without surgery. Surgical drainage was associated with higher hospital charges and longer lengths of stay.