Clinical and CT predictors of emergency airway intervention in patients with deep neck space infections: a systematic review

Deep neck space infections threaten airway patency through edema, tissue displacement, and extension into adjacent anatomical compartments. Identifying patients requiring urgent airway protection is a challenge in emergency care. This review examined clinical and computed tomography predictors of airway intervention and distinguished these findings from predictors of technically difficult intubation. Original observational studies published through 31 May 2026 were examined for associations between presenting characteristics, imaging findings, and airway outcomes. Eleven reports about the encompassing airway prediction models, tracheostomy cohorts, and studies of perioperative airway difficulty. Findings were summarized narratively because populations, outcome definitions, and analytical approaches differed. Dyspnea, multispace involvement, gas formation, retropharyngeal disease, and mediastinitis were the most clinically relevant reported factors. A multicenter model identified dyspnea, multispace involvement, and gas formation as independent predictors and achieved validation discrimination of 0.947. Another cohort identified older age, involvement of at least three spaces, and mediastinitis as independent correlates of tracheostomy. Restricted mouth opening and supraglottic distortion were associated with advanced intubation techniques, while arytenoid edema and pharyngeal abscesses were associated with prolonged postoperative airway support. Diabetes and inflammatory abnormalities provided additional contextual information. Clinical assessment combined with anatomical CT evaluation offers a stronger basis for airway risk recognition than isolated symptoms. Retrospective designs and heterogeneous endpoints limit certainty, supporting prospective validation with standardized definitions of emergency airway intervention.