2080915 Impact of Bedside Ultrasound on Emergency Department Length of Stay in Patients With a Suspected Peritonsillar Abscess: A Case Series

Abstract

Patients presenting to the Emergency Department (ED) with a peritonsillar abscess often pose a diagnostic dilemma, as clinical impression is often unreliable. Once correctly diagnosed, literature demonstrates that emergency physician (EPs) drain abscesses with a 50% success rate. Bedside ultrasonography (US) has been described in both the diagnosis and drainage of a petitonsillar abscess. Furthermore, US gives the EPs the ability to identify other conditions, which may not be visible on physical exam alone. The impact on ED length of stay has been inadequately studied. We performed a retrospective chart review of all patients over 21 years of age who presented to the ED at an academic level 1 trauma center between 1/2011-2/2014 with billing code: “peritonsillar abscess”. The ED arrival/discharge times were obtained from electronic records and length of stay was determined. In patients that had bedside US, the use of CT scan/ENT consultations and presence of any return visits within 30 days were recorded. Out of a sample of 75 initial charts, 7 had documented bedside US performed and are described. 4 patients were diagnosed with a peritonsillar abscess. These patients had US guided abscess drainage performed by an EP. Out of these, 3 received intravenous (IV) antibiotics in the ED and 2 were given a steroid injection. All were discharged on oral antibiotics. Additionally, one patient was diagnosed with pharyngitis, one with tonsillitis, and another with peritonsillar cellulitis. The patient with pharyngitis was seen 2 days prior and diagnosed with the same. The remaining patients had no prior visits. CT scans and ENT consultations were not obtained in any patients. There were no return visits within the subsequent 30 days. The average ED length of stay for these 7 cases was 160 min. (range: 52 to 270 min.) As a reference point, the ED length of stay for all other cases of suspected PTA during same time frame was 293 min. (range 34 to 780 min.). The use of bedside US in 7 cases of suspected peritonsillar abscess was associated with an ED length of stay of 160 min. Whereas, it was 293 min. for cases that bedside US was not performed.