Indications for tonsillectomy

Abstract

We published a three-cycle audit on a similar theme in 2002.1 We looked at 181 children at a paediatric teaching hospital undergoing tonsillectomy in three cohorts to determine adherence to the SIGN guidelines for tonsillectomy and to assess adequate record keeping. The first cohort of patients was listed for surgery prior to the publication of the Scottish Intercollegiate Guidelines Network (SIGN) guidelines; the second after. We then analysed the data for these two cohorts, presented them to the relevant clinicians, and kept a reminder poster (of the SIGN guidelines) placed in each out-patient room prior to the third cohort. Although we found a significant improvement in record keeping (chi-squared test) in cohort 1 to 2 P < 0.001, and cohort 2 to 3 P < 0.001, we did not find a statistically significant result in adherence to the SIGN guidelines In our study we set a standard of 95% adherence to the SIGN guidelines, which we were successful in achieving during the third cycle. There is no specifically mentioned standard in the audit of Toh et al. and we note that, after their second cycle, adherence to all four SIGN recommendations was still only 44% (74% during our second cycle), despite dissemination of audit findings of the first cycle to clinical staff, SIGN guideline posters and introduction of rubber stamp; perhaps this could be improved upon further with a third cycle to meet an appropriate standard? We acknowledge that any improvement is desirable; however, one would expect better results when all other indications for tonsillectomy have been excluded and there was an additional change implemented (the rubber stamp) in comparison with our study. We emphasise that a third cycle in the audit would have contributed even further in improving clinical practice. It is also surprising that the paper makes no reference to the National Prospective Tonsillectomy audit2 or Scottish tonsillectomy audit3 that provide valuable reference points for any study on tonsillectomy.