Steroids for Pediatric Retropharyngeal and Parapharyngeal Abscesses

Written by Sam Parnell

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Corticosteroid use for pediatric patients with retropharyngeal abscesses (RPAs) or parapharyngeal abscesses (PPAs) was associated with lower rate of surgical drainage, less frequent opioid use, and reduced hospital costs.

Why does this matter?
RPAs and PPAs are rare but potentially life-threatening diagnoses. They are most often diagnosed in children, and the incidence of these diseases has been increasing over the past 20 years. RPAs and PPAs can be treated with medical management alone (antibiotics, hydration, and analgesia) or in combination with surgical drainage. Would the addition of corticosteroids to medical management provide any benefit and possibly reduce the need for surgical drainage?

More meds = less scalpel?

Design: This was a multicenter, retrospective study of children aged 2 months to 8 years admitted to a PHIS participating hospital from January 2016 to December 2019 with a diagnosis of RPA or PPA. Children with complex chronic conditions or neck trauma were excluded. Included in the study were 2,259 patients with 1,677 (74.2%) in the non-corticosteroid group and 582 (25.8%) in the corticosteroid group.

Results: The primary outcome of surgical drainage occurred less often in the corticosteroid group compared to the non-corticosteroid group (22.2% vs 51.5%; P < .001). However, more patients who received corticosteroids had delayed surgery compared to the patients who did not receive corticosteroids (59.7% vs 29.4%; P < .001). Patients in the corticosteroid group had less frequent opioid medication use (45.2% vs 54.4%; P < .001), reduced length of stay (median 4 hours shorter; P = .02), and lower overall hospital costs (RR: 0.92; 95% CI: 0.88–0.97; P < .001). Patients in the corticosteroid group were 2.2-times more likely to have return ED visit within one week (95% CI: 1.24–4.05, P=.009) but rates of 30-day hospital readmission did not differ between the groups.

Limitations: The study had several limitations including its observational design, significant heterogeneity regarding corticosteroid and antibiotic use, and several potential confounders. In addition, information about the patient’s exam and diagnostic results (imaging findings) was not available.

Implications: This study suggests that including corticosteroids for medical management of RPAs and PPAs is associated with reduced need for surgical drainage, less opioid use, and lower hospital costs. I would like to see more data on corticosteroids (specifically an RCT), but based on this study, l will be giving my patients with RPAs and PPAs corticosteroids in the future.

Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses. Pediatrics. 2021 Nov;148(5):e2020037010. doi: 10.1542/peds.2020-037010. Epub 2021 Oct 25.

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