The incidence of pediatric head and neck abscesses was more than 3-fold higher in the postpandemic period compared with the prepandemic period.
Investigators conducted a retrospective cohort study of 194 patients aged 18 years or younger with clinically or radiographically confirmed head and neck abscesses treated at Children’s Nebraska and the University of Nebraska Medical Center from January 2017 to December 2024. The cohort included 37 patients from the prepandemic period, 23 from the COVID-19 lockdown period, and 134 from the postpandemic period. Incidence was calculated using unique pediatric emergency department (ED) patients in each period to account for differences in health care utilization. The authors also used Epic Cosmos data to contextualize broader trends.
The investigators evaluated incidence across cervical lymphadenitis with abscess, peritonsillar or intratonsillar abscess, deep neck space abscess, intracranial abscess, and cutaneous or soft-tissue abscesses of the head and neck. Secondary assessments included patient demographics and medical history, clinical presentation, microbiology, abscess size, hospital admission, antibiotic treatment, surgical intervention, and treatment duration.
Head and neck abscess incidence increased across each study period, from 3.34 cases per 10,000 ED patients per year prepandemic to 6.13 during lockdown and 10.95 postpandemic. The postpandemic incidence was 3.28-fold higher than the prepandemic incidence.
The increase extended across several anatomic subtypes. Compared with the prepandemic period, postpandemic was significantly higher for cervical lymphadenitis with abscess, peritonsillar abscess, retropharyngeal or parapharyngeal abscess, and the “other” category, which included intracranial, laryngeal, intraorbital, and intratonsillar abscesses. Cutaneous or soft-tissue head and neck abscess incidence increased numerically but did not reach statistical significance.
Patient characteristics did not appear to account for the increase. The investigators found no statistically significant differences among the 3 periods in age, sex, race, ethnicity, pediatric bacterial vaccination rates, hospital admission rates, or initial examination findings. No patients in the cohort were immunocompromised, and inflammatory laboratory markers also did not differ significantly among periods.
Mean abscess diameter was 2.4 cm prepandemic, 3.45 cm during lockdown, and 2.46 cm postpandemic. Although the overall comparison across the 3 periods was statistically significant, none of the individual pairwise comparisons reached statistical significance. Microbiologic findings predominantly included expected organisms, such as Streptococcus species, Staphylococcusaureus, and typical oropharyngeal flora. The authors did not identify a new dominant pathogen associated with the increased incidence.
Clinical management was also largely similar across periods. The investigators found no statistically significant differences in time to initial or effective antibiotic therapy, time to first surgical intervention, hospital length of stay, total infection duration, or overall surgical intervention rates. Among patients who underwent an intervention, 15 postpandemic patients required more than 1 procedure compared with 1 prepandemic patient, although the difference was not statistically significant. Inpatient mortality was 0% in all 3 periods.
The authors noted several limitations. Both institutions were located in eastern Nebraska, limiting geographic and demographic generalizability. Microbiologic analyses were constrained by incomplete culture and susceptibility data, and the relatively small prepandemic and lockdown cohorts reduced statistical power. Airway compromise and intensive care unit admission were not systematically collected. The Epic Cosmos data also lacked the clinical detail necessary to confirm abscess diagnoses. Most importantly, the observational study could not establish causality or determine whether proposed factors such as altered immune priming, shifts in pathogen epidemiology, health care access, antibiotic prescribing, or socioeconomic factors explained the postpandemic increase.
The findings suggest that the higher incidence of pediatric head and neck abscesses persisted following the pandemic despite largely similar demographic and treatment-related characteristics across the study periods. “These findings highlight the need for ongoing surveillance with prompt recognition and management of pediatric infections in the post-pandemic era,” wrote lead study author Marco DiBlasi, of Creighton University School of Medicine, and colleagues.
Disclosures: The authors reported no conflicts of interest. The study was supported by the Department of Otolaryngology at the University of Nebraska Medical Center.
Source: The Laryngoscope
