Advertisement

Predictors and Risk Factors for admission to Critical Care in Cervicofacial Infections ; A Maxillofacial Trainees Research Collaborative (MTReC) Study

Published:November 18, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.09.015

      Abstract

      Background

      Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management, and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care.

      Methods

      Prospective data was captured for 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainees Research Collaborative (MTReC). Patients admitted to critical care were compared with those receiving ward level care. Multivariate and receiver operating characteristic curve analyses was used to identify the predictors for critical care admission.

      Results

      Our results show three or more features of airway compromise was the best predictor for critical care admission (AUC 0.779) followed by C-reactive protein (CRP) > 100 mg/L (OR 2.70; CI 1.59 – 4.58 P <0.005), submandibular space involvement (OR 3.82; Confidence Interval (95% CI) 1.870 – 7.81 P=0.003), white cell count (WCC) > 12 x 109/ dl (1.05; (95% CI)1.01 - 1.10 p = 0.03), systemic inflammatory response syndrome criteria positive (OR 2.78; CI 1.35 – 5.80 P = 0.006).

      Conclusions

      Admission to critical care is multi-factorial however three or more features of airway compromise was the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow early recognition of patients who may require escalation to critical care.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • De Backer T.
        • Bossuyt M.
        • Schoenaers J.
        Management of necrotizing fasciitis in the neck.
        J Craniomaxillofac Surg. 1996; 24: 366-371
        • Carter L.
        • Lowis E.
        Death from overwhelming odontogenic sepsis: a case report.
        Br Dent J. 2007; 203: 241-242
        • Gonzalez-Garcia R.
        • et al.
        Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations.
        J Craniomaxillofac Surg. 2011; 39: 335-339
        • Byers J.
        • Lowe T.
        • Goodall C.A.
        Acute cervico-facial infection in Scotland 2010: patterns of presentation, patient demographics and recording of systemic involvement.
        Br J Oral Maxillofac Surg. 2012; 50: 626-630
      1. Handley T, D.M., Koppel, D, McCaul JA, The Sepsis Syndrome in Odontogenic Infection. Journal of Intensive Care Society, 2009. 10(1): p. 21 - 25.

        • Colbert S.
        • Cameron M.
        • Williams J.
        Septic thrombosis of the cavernous sinus and dental infection.
        Br J Oral Maxillofac Surg. 2011; 49: e25-e26
        • Clifton T.C.
        • Kalamchi S.
        A case of odontogenic brain abscess arising from covert dental sepsis.
        Ann R Coll Surg Engl. 2012; 94: e41-e43
        • Neff S.P.
        • Merry A.F.
        • Anderson B.
        Airway management in Ludwig's angina.
        Anaesth Intensive Care. 1999; 27: 659-661
        • Candamourty R.
        • et al.
        Ludwig's Angina - An emergency: A case report with literature review.
        J Nat Sci Biol Med. 2012; 3: 206-208
      2. Office for National Statistics (ORN). Hospital Episode Statistics for England. Admitted Patient Care statistics, 2018-19. 2019; Available from: www.hesonline.nhs.uk.

      3. Office for National Statistics (ORN). Hospital Episode Statistics for England. Admitted Patient Care statistics, 2018-19. 2019; Available from: www.hesonline.nhs.uk.

      4. World Health Organisation. Family of International Classifications: definition, scope and purpose. 2004; Available from: who.int/classifications/icd/docs/en/WHOFICFamily.pdf

        • Knuf K.M.
        • Maani C.V.
        • Cummings A.K.
        Clinical agreement in the American Society of Anesthesiologists physical status classification.
        Perioper Med (Lond). 2018; 7: 14
        • Comstedt P.
        • Storgaard M.
        • Lassen A.T.
        The Systemic Inflammatory Response Syndrome (SIRS) in acutely hospitalised medical patients: a cohort study.
        Scand J Trauma Resusc Emerg Med. 2009; 17: 67
        • Fu B.
        • et al.
        Increasing Use of Intensive Care Unit for Odontogenic Infection Over One Decade: Incidence and Predictors.
        J Oral Maxillofac Surg. 2018; 76: 2340-2347
        • Agarwal A.K.
        • et al.
        Role of socioeconomic factors in deep neck abscess: A prospective study of 120 patients.
        Br J Oral Maxillofac Surg. 2007; 45: 553-555
        • Zheng L.
        • et al.
        The clinical features of severe multi-space infections of the head and neck in patients with diabetes mellitus compared to non-diabetic patients.
        Br J Oral Maxillofac Surg. 2012; 50: 757-761
        • Prin M.
        • Wunsch H.
        International comparisons of intensive care: informing outcomes and improving standards.
        Curr Opin Crit Care. 2012; 18: 700-706
      5. MTReC Writing Group, M.C., Stress hyperglycaemia or diabetes mellitus in cervicofacial infections? a Maxillofacial Surgery Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg, 2021. 21.

        • Sainuddin S.
        • et al.
        New admission scoring criteria for patients with odontogenic infections: a pilot study.
        Br J Oral Maxillofac Surg. 2017; 55: 86-89
        • Heim N.
        • et al.
        The role of C-reactive protein and white blood cell count in the prediction of length of stay in hospital and severity of odontogenic abscess.
        J Craniomaxillofac Surg. 2018; 46: 2220-2226
        • Stathopoulos P.
        • et al.
        Predictive factors of hospital stay in patients with odontogenic maxillofacial infections: the role of C-reactive protein.
        Br J Oral Maxillofac Surg. 2017; 55: 367-370