The validity of lateral neck X-Ray for the diagnosis of retropharyngeal infection in pediatric patients

Abstract

Aim

To examine the validity of lateral neck x ray (LNXR) for the diagnosis of retropharyngeal infection (RPI) in emergency room (ER) settings. Effectiveness of conservative treatment with IV antibiotics for RPI was also examined.

Methods

A retrospective analysis of patients diagnosed with RPI at a university-affiliated primary care center, between the years 2012–2022. Pre-vertebral space diameter at C2 level on LNXR was compared to a control group as well as before and after treatment. A sensitivity analysis was performed.

Results

44 and 20 patients were included in the study and control group, respectively. Median pre-vertebral thickness was significantly different between the groups (14.9 mm [IQR: 12.5, 18.4] vs. 4.1 mm [3.6, 5], p < 0.001). Sensitivity and specificity of LNXR combined with clinical presentation for RPI diagnosis were 87 % and 74 %, respectively. Median pre-vertebral space diameter before and after treatment declined significantly (14.3 mm [12.3, 18.1] vs. 7.2 mm [4.6, 9.6], p < 0.001).

Conclusions

LNXR is a good and valid modality for the diagnosis of RPI, in conjunction with clinical presentation in ER setting. IV antibiotics are efficient for most children with RPI. Neck CT and surgical intervention should be reserved for select patients.