Elena Chiappini1, Angelo Camaioni2, Marco Benazzo3, Andrea Biondi4, Sergio Bottero5, Salvatore De Masi6, Giuseppe Di Mauro7, Mattia Doria8, Susanna Esposito9, Giovanni Felisati10, Dino Felisati10, Filippo Festini11, Renato Maria Gaini12,13, Luisa Galli1, Claudio Gambini14, Umberto Gianelli15, Massimo Landi16, Marco Lucioni17, Nicola Mansi18, Rachele Mazzantini1, Paola Marchisio9, Gian Luigi Marseglia19, Vito Leonardo Miniello20, Marta Nicola21, Andrea Novelli22, Marco Paulli23, Marina Picca24, Marta Pillon25, Paolo Pisani26, Carlotta Pipolo27, Nicola Principi9, Iacopo Sardi28, Giovanni Succo29, Paolo Tomà30, Enrico Tortoli31, Filippo Tucci32, Attilio Varricchio33, Maurizio de Martino1. 1. a Paediatric Infectious Disease Unit, Department of Health Sciences , University of Florence, Anna Meyer Children's University Hospital , Florence , Italy. 2. b ENT Department , San Giovanni-Addolorata Hospital , Rome , Italy. 3. c Department of Otorhinolaryngology, "San Matteo" Hospital , University of Pavia , Pavia , Italy. 4. d Paediatric Haematology-Oncology Department and "Tettamanti" Research Centre , Milano-Bicocca University, "Fondazione Mbbm", San Gerardo Hospital , Monza , Italy. 5. e ENT Unit, Department of Surgery and Transplantation Centre , Bambino Gesù Children's Hospital, IRCCS , Rome , Italy. 6. f Epidemiology Unit, Meyer University Hospital , Florence , Italy. 7. g Primary Care Pediatrician , Caserta , Italy. 8. h General Paediatrician , Milan , Italy. 9. i Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico , Università Degli Studi Di Milano, Milan , Milan , Italy. 10. j Department of Otolaryngology , San Paolo Hospital, University of Milan , Milan , Italy. 11. k Department of Health Science , University of Florence , Florence , Italy. 12. l Department of Otorhinolaryngology , San Gerardo Hospital , Monza , Italy. 13. m Department of Surgery and Translational Medicine , University of Milano-Bicocca , Milan , Italy. 14. n Pathology Unit , Istituto Giannina Gaslini , Genua , Italy. 15. o Fondazione Ircss Ca' Granda-Ospedale Maggiore Policlinico , Italy University of Milan , Milan , Italy. 16. p General Paediatrician , Turin , Italy. 17. q Otolaryngology Unit , Vittorio Veneto Hospital , Vittorio Veneto , Italy. 18. r ENT Unit , Santo Bono Posillipo Hospital , Naples , Italy. 19. s Department of Pediatrics , University of Pavia, Fondazione Irccs Policlinico San Matteo , Pavia , Italy. 20. t Department of Paediatrics , Aldo Moro University of Bari , Bari , Italy. 21. u Department of Molecular Medicine , University of Pavia , Pavia , Italy. 22. v Department of Health Sciences, Section of Pharmacology , University of Florence , Florence , Italy. 23. w Department of Pathology, Fondazione Irccs Policlinico San Matteo, and Department of Molecular Medicine , University of Pavia , Pavia , Italy. 24. x Primary Care Paediatrician , Milan , Italy. 25. y Oncoemaology Unit, Department of Paediatrics , University of Padua , Padua , Italy. 26. z Otorhinolaryngology Unit, Head and Neck Department , San Paolo Hospital, University of Milan , Milan , Italy. 27. aa Department of Cardiovascular Surgery , Ncc Città Di Alessandria Hospital , Alessandria , Italy. 28. ab Neuro-Oncology Unit, Meyer Meyer Univeristy Hospital , Florence , Italy. 29. ac Otorhinolaryngology Service, Department of Oncology , San Luigi Gonzaga Hospital, University of Turin , Turin , Italy. 30. ad Department of Diagnostic Imaging , Children's Hospital Bambino Gesù , Rome , Italy. 31. ae San Raffaele Institute , Milan , Italy. 32. af University Hospital Pediatric Department , Bambino Gesù Children's Hospital, Rome , Rome , Italy. 33. ag San Gennaro Hospital , Naples , Italy.
Abstract
UNLABELLED: Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children. METHODS: The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014. RESULTS: Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified. CONCLUSION: The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.
UNLABELLED: Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children. METHODS: The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014. RESULTS: Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified. CONCLUSION: The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.
Entities:
Keywords:
algorithm; cervical lymphadenopathy; children; evidence based medicine
Authors: F Scasso; G Ferrari; G C DE Vincentiis; A Arosio; S Bottero; M Carretti; A Ciardo; S Cocuzza; A Colombo; B Conti; A Cordone; M DE Ciccio; E Delehaye; L Della Vecchia; I DE Macina; C Dentone; P DI Mauro; R Dorati; R Fazio; A Ferrari; G Ferrea; S Giannantonio; I Genta; M Giuliani; D Lucidi; L Maiolino; G Marini; P Marsella; D Meucci; T Modena; B Montemurri; A Odone; S Palma; M L Panatta; M Piemonte; P Pisani; S Pisani; L Prioglio; A Scorpecci; L Scotto DI Santillo; A Serra; C Signorelli; E Sitzia; M L Tropiano; M Trozzi; F M Tucci; L Vezzosi; B Viaggi Journal: Acta Otorhinolaryngol Ital Date: 2018-04 Impact factor: 2.124