Utilization of emergency department computed tomography and otolaryngology consultation in the diagnosis of pediatric peritonsillar abscess

Int J Pediatr Otorhinolaryngol. 2019 Feb;117:189-193. doi: 10.1016/j.ijporl.2018.11.034. Epub 2018 Nov 30.

Abstract

Objectives: To determine whether obtaining a computed tomography (CT) scan in the emergency department (ED) is predictive of peritonsillar abscess (PTA) in the pediatric population, and to evaluate for clinical characteristics that may suggest whether a CT is beneficial in the diagnosis of pediatric PTA.

Methods: Single-institution retrospective chart review at Rush University Hospitals. Study included pediatric patients, aged 17 or younger, who presented to the ED with suspected PTA over a 6-year period. Patients received a neck CT and/or an official otolaryngology consultation. Relevant demographic and study parameters were collected and statistically analyzed using SPSS.

Results: A total of 36 pediatric patients with suspected PTA. Of these, 47.2% (17/36) received a diagnosis of PTA while 52.8% (19/36) received an alternative diagnosis. Patients with PTA were more likely to have trismus (41.2% vs 5.3%; p < .01), uvular deviation (94.1% vs 15.8%; p < .01), and palatal edema (52.9% vs 10.5%; p < .01), compared to patients without PTA. Fewer CT scans were ordered when comparing PTA positive versus negative cohorts (35% vs 63.2%; p = .10), however this was not statistically significant. An otolaryngology consult prior to imaging did significantly reduce the frequency of ordered CT scans (12.5% vs 63.6%; p < .01).

Conclusion: This is the first study to investigate the benefit of CT imaging in the diagnosis of pediatric PTA and impact of an otolaryngology consult on the frequency of CT scans. Pediatric patients at high risk for PTA based on clinical findings may not require CT imaging for diagnosis. Patients at lower risk may benefit from imaging based on the availability of an otolaryngology consult or expertise of the examiner.

Keywords: Clinical assessment; Computed tomography (CT); Otolaryngology consult; Peritonsillar abscess (PTA).

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Edema / etiology*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Incidence
  • Male
  • Mouth Diseases / etiology*
  • Otolaryngology*
  • Palate
  • Peritonsillar Abscess / complications
  • Peritonsillar Abscess / diagnosis*
  • Peritonsillar Abscess / epidemiology*
  • Referral and Consultation*
  • Retrospective Studies
  • Tomography, X-Ray Computed*
  • Trismus / etiology
  • Uvula