Management of paediatric neck abscess with needle aspiration against surgical drainage: Systematic review and meta-analysis.

Abstract

<h4>Aims</h4>Paediatric neck abscesses can lead to complications such as airway obstruction, thrombophlebitis, and sepsis. While open incision and drainage (I&D) is the gold standard for patients unresponsive to medical treatment, needle aspiration is increasingly gaining interest. This systematic review and meta-analysis aim to evaluate the effectiveness and safety of needle aspiration compared to I&D in managing paediatric neck abscesses.<h4>Methods</h4>A systematic review and meta-analysis of databases (Ovid Medline, Embase, SCOPUS) and clinical trial registries (Cochrane CENTRAL, ANZCTR) was conducted unto and including August 31, 2024 for MeSH terms pertaining to "paediatric", "neck abscess", "aspiration" and "drainage". Studies investigating paediatric patients who underwent needle aspiration for management of lateral neck abscess were included. The primary outcome was log odds ratio for recurrence rate and the comparator was incision and drainage (I&D). PROSPERO CRD42024585424.<h4>Results</h4>Of 2464 studies, 13 studies with 741 patients (n = 314 needle, 427 I&D) underwent data analysis. Seven studies directly compared needle aspirations against I&D (106 vs 427 patients respectively). Needle aspiration showed a statistically significant higher failure rate (OR -1.86, 95 %CI -2.19 to -0.81). While the pooled failure rate of a single needle aspiration in 314 patients was 15.83 % (95 %CI 3.61 to 32.32, I2 86.12 %), readmission rates <30 days were higher in the I&D group (1.64 %, n = 7/427) compared with needle aspiration (0.96 %, n = 3/314). There were no major complications reported. Sensitivity analysis did not change the conclusion.<h4>Conclusions</h4>While open I&D remains the gold standard, needle aspiration may be considered as a treatment option for paediatric neck abscesses based upon institution preferences, patient selection, and resources.