Acute adenitis in children: clinical course and factors predictive of surgical drainage.

OBJECTIVES: To describe clinical course of children hospitalized for a first episode of acute unilateral infectious adenitis and to identify factors predictive of surgical lymph node drainage.

METHODS: We reviewed medical records of children from 0 to 17 years of age discharged from a tertiary care pediatric center with a diagnosis of adenitis between 1 April 1996 and 31 March 2001. Patients were included if they had acute (< or = 10 days) unilateral lymph node swelling greater or equal to 2.5 cm on initial physical examination. Exclusion criteria were: bilateral adenitis or adenitis at more than one site; prior adenitis; underlying chronic disease.

RESULTS: Two hundred and eighty-four patients were included in this study. The mean age was 4.0 years (3.1 SD). Twenty-three per cent of infected nodes were > 5 cm in size and 92.6% were cervical. Thirteen of 252 blood cultures were positive (5.2%), of which one showed Streptococcus pneumoniae and 12 contaminants. Mean length of stay was 4.2 days (2.2 SD). Surgical node drainage was performed in 60 (21.1%) patients. Factors significantly associated with increased risk of surgical drainage were age < 1 year (adjusted OR: 14.5; 95% CI: 5.0-42.2) and node involvement > 48 h (adjusted OR: 2.9; 95% CI: 1.2-7.2). There were no major complications. Follow-up was documented in 183 patients, of whom 92.3% achieved complete healing.

CONCLUSIONS: Children hospitalized for a first episode of acute unilateral infectious adenitis generally do well. Younger patients and those with longer duration of node involvement before admission have an increased risk of surgical node drainage.