Abstract
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. Prospective data were captured on 1002
patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial
Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared
with those who received ward-level care. Multivariate and receiver operating characteristic
curve analyses were used to identify predictors for critical care admission. Our results
show that the best predictor for critical care admission is the presence of three
or more features of airway compromise (AUC 0.779), followed by C-reactive protein
(CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement
(OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 109/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response
syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care
is multifactorial, however, the presence of three or more features of airway compromise
is the best predictor. Awareness of this alongside other key clinical findings in
cervicofacial infections may allow for the early recognition of patients who may require
escalation to critical care.
Keywords
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Article info
Publication history
Published online: November 18, 2022
Accepted:
September 23,
2022
Identification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
