Pediatric necrotizing soft tissue infections of the head and Neck: A case report and systematic review.

INTRODUCTION

Pediatric necrotizing soft tissue infection (NSTI) of the head and neck is a rare (0.08 per 100,000 children per year) but life-threatening condition requiring prompt diagnosis and treatment. This systematic review aims to describe a case report and synthesize the current literature to identify key clinical features, management strategies, and outcomes of this rare condition.

METHODS

Medline (Ovid), Embase, the Cochrane library, and Web of Science were searched for articles that described pediatric patients who had NSTI of the head and neck. Data on patient factors, microbiology, treatment, and outcomes were extracted.

RESULTS

56 cases of pediatric NSTI of the head and neck were identified from 47 articles. Mean age of occurrence was 5.2 ± 5.3 years (61 % male). Mean time to presentation was 3.2 ± 4.4 days. Most common initial presenting symptoms included overlying skin erythema (n = 37/56, 66 %), edema (n = 36/56, 64 %), fever (n = 31/56, 55 %), pain (n = 19/56, 34 %), tachycardia (n = 16/56, 29 %), hypotension (n = 15/56, 27 %), and skin necrosis (n = 8/56, 14 %). Anatomical location of head and neck NSTI involvement was most commonly reported in cervicofacial (45/56, 80 %), craniocervical (8/56, 14 %), and thoracocervical (7/56, 13 %). Of known aetiologies, the most frequently reported were traumatic/iatrogenic (n = 11/56, 20 %) and odontogenic (n = 7/56, 13 %). In 41 % of cases the etiology of NSTI was unknown (23/56). Imaging was performed prior to the initial OR in 59 % of cases (n = 33/56) and computed tomography (CT) was the most common imaging modality (43 %, 24/56). Mean time to first surgical debridement was 1.3 ± 3.4 days. The most frequently identified microorganism was Group A Streptococcus (n = 13/56, 23 %), polymicrobial (n = 11, 20 %), Staphylococcus (n = 6/56, 11 %), and Pseudomonas (n = 6/56, 11 %). Almost one half (n = 19/41, 46 %) of the cases required more than one surgical debridement, and the overall average number of debridements was 2.3 ± 2.0. Mean length of hospital stay was 30 ± 25 days and overall mortality was 5 % (3/56).

CONCLUSION

Pediatric NSTI of the head and neck is a rare, life-threatening condition requiring early recognition and aggressive management. Prompt diagnosis, timely surgical debridement, and a multidisciplinary approach are critical to improving outcomes in this vulnerable population.