Factors associated with severe deep neck space infections: targeting multiple fronts

OBJECTIVES: To determine factors predictive of a severe deep neck space infection (DNSI), defined as those requiring surgery and/or postoperative intensive care unit (ICU) admission. To specifically examine dental practices and socioeconomic factors that may contribute to the development of a DNSI. STUDY DESIGN: Retrospective review. METHODS: This study was conducted at 2 tertiary care academic referral centers from January 2007 to September 2011. The study was composed of 2 arms: a prospective questionnaire and data collection to identify modifiable risk factors such as dental practices and socioeconomic considerations for a DNSI, and a retrospective review of deep neck space infections to identify commonly associated risk factors predictive of a severe DNSI, requiring surgery and/or postoperative ICU admission. RESULTS: 233 patients were reviewed retrospectively and 25 patients prospectively. Patients with a low level of education (p = 0.03), those living greater than 1 hour from a tertiary care center (p = 0.002), those that have tonsils (p = 0.03), and those with Streptococcus infections (p = 0.03) have an increase risk of developing a severe DNSI. Patients that were smokers (p = 0.02) or had diabetes (p = 0.02), and those that presented with airway compromise (p = 0.03) were more likely to have a prolonged hospital stay. CONCLUSIONS: Factors predictive of severe DNSIs are Streptococcus infections, the presence of tonsils, education level, and geographic location.