Predictors of pediatric intensive care unit admission in pediatric deep neck infections: A retrospective observational study

Deep neck infections (DNIs) in children can progress rapidly and lead to life-threatening complications. Early identification of patients at high risk for severe disease is essential for timely intervention and optimal allocation of pediatric intensive care unit (PICU) resources. This study aimed to identify clinical and laboratory predictors associated with PICU admission in children diagnosed with DNIs in the pediatric emergency department. This retrospective, single-center study included pediatric patients diagnosed with DNIs from January 1 to December 31, 2024. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records. Patients were categorized according to admission to the PICU or pediatric ward. Statistical analyses were performed to identify independent predictors of PICU admission. A total of 107 patients (53.3% male; median age, 95.0 months) were included. The most common abscess types were peritonsillar (52.3%), parapharyngeal (27.1%), and retropharyngeal (20.6%). Dysphagia (P = .013), tonsillar hypertrophy (P = .039), and trismus (P = .015) were significantly more common among PICU patients. Laboratory findings showed higher white blood cell (WBC) counts (P = .048), absolute neutrophil counts (P = .010), and C-reactive protein (CRP) levels (P < .001), and lower absolute lymphocyte counts (P = .001) in the PICU group. Elevated CRP (≥50 mg/L; P = .018) and WBC (≥15.0 × 109/L; P = .040) were independently associated with PICU admission. Dysphagia, tonsillar hypertrophy, restricted mouth opening, and elevated inflammatory markers particularly high WBC and CRP are potential early predictors of severe DNIs requiring intensive care. Recognition of these indicators may support prompt triage, efficient use of critical care resources, and timely interventions to prevent serious complications.