Trends in Hospitalizations for Pediatric Peritonsillar Abscess: 2003‐2009

Abstract

Objectives: Peritonsillar abscesses (PTA) are the most common deep neck space infections. Although many of these infections are treated in the emergency department, these infections can become quite serious, compromising the airway or developing into Lemierre’s Syndrome, requiring hospitalization. We embarked on this study to determine current hospitalized costs, length of stay (LOS), and demographic stratification of peritonsillar abscess. Methods: This study used the Kid Inpatient Database for 2003, 2006, and 2009. We queried this for International Classification of Disease, ninth revision, clinical modification (ICD-9-CM) code 475.00, representing PTA. We obtained stratified data for this diagnosis. Hospital resource use was compared between teaching, non-teaching, and pediatric facilities using Statistical Analysis Software. Census data were used to calculate incidences. Results: The number of hospitalizations and incidence increased (3608 to 4502, 3.7 to 4.5/100000population). Hospitalizations increased with increasing age (for 15-19 yo vs other ages RR 2.18, 95%CI 2.14-2.22). Percent of cases receiving surgical drainage decreased (41% to 34%). Median LOS remained constant at 2 days. Patients had longer LOS at pediatric hospitals (2.3d vs 2.14d vs 2.02d, P < 0.001) accruing more charges ($14763 vs $10587 vs $9120, P < 0.001). Pediatric and teaching hospitals performed more drainage than nonteaching (39.4% and 40.4% vs 36.1%, P < 0.001). Conclusions: Incidence of pediatric hospitalizations for PTA increased from 2003-2009. These infections were more common among adolescents. Surgical management decreased. Overall cost per case increased, while LOS remained constant. The national emergence of community-acquired MRSA during this time period may be related to the increase in incidence.