Computed tomography use patterns for pediatric patients with peritonsillar abscess

Kasey W Rawlins; David Z Allen; Amanda J Onwuka; Charles A Elmaraghy

doi:10.1016/j.ijporl.2019.04.027

Computed tomography use patterns for pediatric patients with peritonsillar abscess

Int J Pediatr Otorhinolaryngol. 2019 Aug:123:22-25. doi: 10.1016/j.ijporl.2019.04.027. Epub 2019 Apr 24.

Authors

Kasey W Rawlins¹, David Z Allen¹, Amanda J Onwuka², Charles A Elmaraghy³

Affiliations

¹ The Ohio State University Wexner Medical Center, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA.
² The Research Institute at Nationwide Children's Hospital, Center for Surgical Outcomes Research, Columbus, OH, USA.
³ The Ohio State University Wexner Medical Center, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA; Nationwide Children's Hospital, Department of Pediatric Otolaryngology-Head and Neck Surgery, Columbus, OH, USA. Electronic address: Charles.elmaraghy@nationwidechildrens.org.

PMID: 31054537
DOI: 10.1016/j.ijporl.2019.04.027

Abstract

Objectives: The objective of this study is to examine the impact that an institution-wide policy to reduce radiation exposure in pediatric patients had on the use of computed tomography (CT) imaging in children presenting with suspected peritonsillar abscess (PTA)1.

Methods: A single institution retrospective review was conducted for all pediatric patients under the age of 18 who presented to the emergency department with suspected PTA over a ten-year period. Patients were divided into two groups; those that presented during the years prior to policy implementation and those that presented during the years following. Main outcome measures were the frequency of patients who underwent CT scanning as a part of their workup, the specialty of the ordering physician, and the treatment for suspected PTA.

Results: A total of 317 patients with suspected PTA were seen prior to policy implementation, with an additional 275 patients seen in the years after. The frequency of CT use was 41% (131/317) in pre-policy patients, and 28% (77/275) in post-policy patients (p = 0.004). The most common specialty of ordering physician was Pediatrics in the pre-policy patients (45%), and Otolaryngology in the post-policy patients (41%) (p = 0.0003). Of the 131 patient who underwent CT scanning before policy implementation, 36 patients (27%) required incision and drainage (I&D) of their PTA in the OR. This is in comparison to 42/77 patients (55%) in the post-policy group who underwent I&D in the OR (p < 0.0001).

Conclusion: An institution-wide policy to decrease unnecessary imaging studies in pediatric patients resulted in a significant reduction in the use of CT imaging in the work-up for suspected PTA. Additionally, there was increase in the frequency of patients who underwent surgical intervention for their PTA after CT imaging, suggesting a more scrutinized approach to CT usage since policy implementation.

Keywords: Computed tomography; Pediatrics; Peritonsillar abscess; Radiation exposure.

MeSH terms

Adolescent
Child
Child, Preschool
Drainage
Emergency Service, Hospital
Female
Hospitals, Pediatric
Humans
Male
Organizational Policy*
Otolaryngology / statistics & numerical data*
Pediatrics / statistics & numerical data*
Peritonsillar Abscess / diagnostic imaging*
Peritonsillar Abscess / surgery
Retrospective Studies
Tomography, X-Ray Computed / statistics & numerical data*
Unnecessary Procedures / statistics & numerical data