Abstract
Objective: Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, affecting thousands of people annually with high treatment costs. The purpose of this project was to determine how in-network emergency departments (EDs) adhere to generally accepted guidelines regarding diagnosis and management of potential PTAs.Methods: The authors performed a retrospective chart review to identify patients with PTA in five EDs in one year. Information pertaining to diagnostic tests, treatment, and airway status was also collected. Descriptive analysis was used to assess if EDs were consistent with generally accepted guidelines.Results: Six hundred twenty-one patient records were identified and 140 were included in final analysis. Out of 140 patients, 71 were admitted for inpatient management and 23 were admitted for observation. Of the 46 patients diagnosed and discharged from the ED, 61% received a computerized tomography (CT) scan and only 39% had PTA drainage performed. Four (3%) patients received a point of care ultrasound and a CT scan and no patient received only an ultrasound. Out of all patients, 116/140 received a CT scan and 22 received drainage in the ED. The remainder of these patients either had drainage performed by an otolaryngologist or had no drainage performed. Of the 94 patients admitted for inpatient or observation, 84 received a CT scan and six received drainage by an ED physician. Only 62% of patients were given a penicillin derivative and 29% were given clindamycin, which has no Gram-negative coverage.Conclusion: One-third of PTA patients were managed within the ED, far less than similar studies. Of these, over 50% received a CT scan and less than 50% had PTA drainage. PTA drainage can improve patients’ symptoms and antibiotic effectiveness. The majority of patients were prescribed a penicillin derivative with or without another antibiotic.
Highlights
Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, affecting 45,000 people per year with annual treatment costs of over $150 million [1]
Some providers prefer to utilize imaging prior to PTA drainage for fear of carotid artery injury, this has not been reported in the literature [5]
295 patients did not have a PTA or peritonsillar cellulitis diagnosis and 186 patients did not present to an in-network emergency departments (EDs) and were excluded from the study, leaving 140 patients in the study (Figure 1)
Summary
Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, affecting 45,000 people per year with annual treatment costs of over $150 million [1]. PTAs present to peritonsillar cellulitis; management is dependent on differentiation. Differentiation can be done by identification of pus on needle aspiration, which is a rapid and inexpensive method, and concurrently treats a PTA [2,3]. Despite this identification method, computerized tomography (CT) scans are utilized in approximately 5-20% of cases possibly because of the high sensitivity and specificity [4]. Some providers prefer to utilize imaging prior to PTA drainage for fear of carotid artery injury, this has not been reported in the literature [5]
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