TOP 41 - Clinical Comparison of Pediatric Cervical Lymphadenitis Patients by Imaging and Treatment Modalities

Publication Number: 2793.TOP 41

Rachel S F. Sivan, Maria Fareri Children's Hospital at Westchester Medical Center, Bronx, NY, United States; Sarah Muharomah, Maria Fareri Children's Hospital at Westchester Medical Center, Hawthorne, NY, United States; Sofia Kling, New York Medical College, New York, NY, United States; Styliana Maimos, New York Medical College, Flushing, NY, United States; Christian E. Ortiz, New York Medical College, White Plains, NY, United States; Karen Hardy Brandstaedter, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States; Aditi Kamat, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States; Ashleigh Halderman, Maria Fareri Children's Hospital at Westchester Medical Center, Croton on Hudson, NY, United States

Background: Cervical lymphadenitis is a common cause of pediatric hospital admission and is often co-managed by pediatric hospitalists and otolaryngologists. While some cases resolve with antibiotics alone, others require surgical intervention due to abscess formation. Diagnostic evaluation of these patients frequently involves imaging, with computed tomography (CT) commonly used despite concerns about radiation exposure and variable clinical benefit. Evidence suggests ultrasound may provide sufficient diagnostic information in many cases, yet guidance for imaging selection remains limited. Improved characterization of clinical predictors of patients more or less likely to require surgical intervention could help stratify patients at presentation and guide selection of initial imaging modality with a goal to reduce unnecessary exposure to radiation and increased cost associated with CT scans, while allowing hospitalists to better plan for non-surgical cases.

Objective: This study aims to determine the clinical and laboratory characteristics influencing imaging selection and treatment decisions in pediatric cervical lymphadenitis at our institution. By identifying predictors of CT use and surgical intervention, our findings may inform institutional guidelines, reduce radiation exposure, and improve resource utilization. This work will support the development of tools to aid clinical decision-making and optimize medical management on a hospitalist service.

Design/Methods: We conducted a retrospective chart review of pediatric patients ( < 18 years old) admitted to Maria Fareri Children's Hospital with cervical lymphadenitis January 2021-December 2024. Eligible cases were identified by ICD-10 codes related to lymphadenitis and neck abscess. Exclusion criteria included significant comorbidities, immunosuppression, relevant advanced imaging within the preceding week, non-infectious/congenital etiologies, and admissions without ED evaluation. Demographic, clinical, laboratory, imaging, and hospital course data were collected by chart review from 96 admissions. Patients were compared in two ways: those who received CT as part of their initial evaluation compared with those who did not, and those who received surgical intervention compared with those who received medical management alone. Statistical comparisons were performed using non-parametric tests. Significant variables were entered into a multivariable logistic regression to develop a tool predicting CT use and surgical management. Continuing analysis will explore associations between presenting features, imaging choice, and management outcomes.

Table 1. Patient Characteristics by Who Underwent Initial CT Scan
Descriptive statistics for comparison between patients who underwent CT scan as initial imaging and patients who did not.

Table 2. Patient Characteristics by Who Required Surgical Intervention
Descriptive statistics for comparison between patients who required surgical intervention and patients who were treated with medical management.