Increased Pediatric Head and Neck Abscesses Following the COVID-19 Pandemic.

Abstract

Concerns have emerged that COVID-19-related public health measures may have altered pediatric immune development and infection patterns, with studies suggesting an increase in pediatric abscesses following the pandemic. This study evaluated changes in the incidence, clinical features, and management of pediatric head and neck abscesses before, during, and after COVID-19 lockdown restrictions. This retrospective cohort study included 194 patients ≤ 18 years with head and neck abscesses at two tertiary institutions from 2017 to 2024. Cases were identified using ICD-10 codes and confirmed by chart review. Patients were stratified into pre-pandemic, lockdown, and post-pandemic cohorts. Incidence rates were calculated using Poisson regression with pediatric emergency department volume as an offset. Variables were compared using Fisher's exact and Kruskal-Wallis tests. National trends were contextualized using Epic Cosmos data. Abscess incidence increased from 3.34 to 6.13 to 10.95 per 10,000 emergency department patients per year across the pre-pandemic, lockdown, and post-pandemic periods, respectively; representing a 3.28-fold increase compared to pre-pandemic levels (p < 0.0001). Incidence increased across all anatomic subtypes, including cervical lymphadenitis with abscess, peritonsillar, deep neck space, and intracranial abscesses. Patient demographics, hospital admission rates, and time to treatment did not differ significantly between cohorts. Abscess size was larger during the lockdown period (p = 0.047). Post-pandemic patients more often required repeat surgical intervention (17.4%) compared to pre-pandemic patients (5.0%). Pediatric head and neck abscesses increased significantly following the COVID-19 pandemic, with a sustained rise independent of demographic or treatment-related factors. Continued surveillance and investigation into post-pandemic pediatric host susceptibility is warranted.