386 - Clinical characteristics and resource utilization in children presenting to the emergency department with neck swelling

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 386
Publication Number: 386.405

Sofia S. Cook, Children's Hospital Los Angeles, Los Angeles, CA, United States; Breahn Donaldson, Children's Hospital Los Angeles, Los Angeles, CA, United States; Pradip P.. Chaudhari, Children's Hospital Los Angeles, Los Angeles, CA, United States; Phung K. Pham, Children's Hospital Los Angeles, Los Angeles, CA, United States; Deborah R.. Liu, Children's Hospital Los Angeles, Los Angeles, CA, United States

Presenting Author(s)

Sofia S. Cook, MD (she/her/hers)

Pediatric Emergency Medicine Fellow
Children's Hospital Los Angeles
Los Angeles, California, United States

Background:

Although neck swelling is a common chief complaint for children presenting to the emergency department (ED), practice variation exists in the use of imaging for these patients. An improved understanding of the clinical characteristics and resource utilization for children with neck swelling will help elucidate the utility of imaging.

Objective: We aimed to describe historical characteristics, physical exam findings, and resource utilization in children presenting to the ED with neck swelling.

Design/Methods: We conducted a single center retrospective cross-sectional electronic health record study of all children < 18 years old who presented to the ED for neck swelling between 1/1/2018 and12/31/2018. Children with neck swelling were identified using ED diagnosis International Classification of Diseases 10^th Revision (ICD-10) codes. The primary outcome was neck imaging performed in the ED (soft tissue ultrasound of the neck [US], soft tissue computed tomography of the neck [CT], or soft tissue neck radiograph [XR]). We used descriptive statistics to describe clinical characteristics and odds ratios to compare resource utilization between ED encounters that did and did not involve imaging.

Results:

We studied 680 ED encounters with neck swelling (Figure 1), 32.4% (n=220) of which involved neck imaging in the ED. When imaging was ordered, US, CT, and XR was ordered in 79% (n=180), 18.4% (n=43), and 4.7% (n=11), respectively. Clinical characteristics and resource utilization are displayed in Table 1. Among all ED encounters, laboratory testing was obtained in 30.7% (n=209) and hospitalization occurred in 16.2% (n=110). Of those discharged home (n=570), median [IQR] ED length of stay (LOS) was 3.6 [2.7, 5.4] hours in encounters with imaging, and 1.9 [1.1, 3.4] hours in encounters without imaging (OR 1.4; 95% CI 1.3-1.5). 30-day revisits were similar between groups (n=22, 10.0% among imaged; n=28, 6.1% among non-imaged, OR 0.61; 95% CI 0.3-1.1).

Conclusion(s):

Historical characteristics and physical exam findings vary among children presenting to the ED with neck swelling, including among those who received diagnostic imaging. Children with imaging had a longer ED LOS with a similar proportion of 30-day revisits between those imaged compared to those not imaged.