Abstract
Background
Physical examination for peritonsillar abscess (PTA) has limited sensitivity. Traditional
management involves blind needle aspiration, which has a false negative rate of 10–24%.
A randomized controlled trial by Costantino et al. demonstrated that point-of-care
ultrasound (POCUS) improves PTA management.
Objectives
Compare the use and impact of POCUS between patient cohorts prior to and after the
trial by Costantino et al.
Methods
Retrospective cohort study of adult patients diagnosed with PTA. Cohort 1 presented
to the emergency department (ED) January 2007–December 2008. Cohort 2 presented between
January 2013 and December 2014. Data were separated into those with POCUS vs. without
ultrasound (NUS). Primary endpoint was POCUS utilization. Secondary endpoints were
successful aspiration, otolaryngology (ear, nose, and throat [ENT]) consultation,
computed tomography (CT) imaging, unscheduled return visits, and length of stay (LOS).
The Fisher's exact and t-tests analyzed data.
Results
Cohort 1 enrolled 48 patients, vs. 114 patients for cohort 2. Twelve patients in cohort
1 had a POCUS (25%) vs 89 in cohort 2 (78%) (p < 0.0001; odds ratio [OR] 0.09 (95% confidence interval [CI] 0.04–0.20). Emergency
physician (EP) successful aspiration: 89.1% POCUS vs. 24.5% NUS (p < 0.0001; OR 25 [95% CI 10–59]). Combined EP/ENT successful aspiration: 99.0% POCUS
vs. 80.3% NUS (p < 0.0001; OR 24 [95% CI 3–193]). ENT consultation:12.9% POCUS vs. 65.6% NUS (p < 0.0001; OR 0.07 [95% CI 0.03–0.17]). CT usage: 23.8% POCUS vs. 37.7% NUS (p = 0.07; OR 0.51 [95% CI 0.25–1.02]). Return visits: 3.96% POCUS vs. 18.0% NUS (p = 0.004; OR 0.18 [95% CI 0.05–0.61]).
Conclusion
POCUS use has increased for PTA treatment, improves aspiration, and decreases consultations,
CTs, return visits, and LOS.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mosher Award Thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines.Laryngoscope. 1995; 105: 1-17
- A unifying theory of tonsillitis, intratonsillar abscess and peritonsillar abscess.Am J Otolarygol. 2015; 36: 517-520
- Peritonsillar abscess: complication of acute tonsillitis or Weber’s glands infection?.J Otolaryngol Head Neck Surg. 2016; 155: 199-207
- Peritonsillar abscess after tonsillectomy: a review of the literature.Ann R Coll Surg Engl. 2011; 93: 353-357
- An evidence-based review of the treatment of peritonsillar abscess.J Otolarygol Head Neck Surg. 2003; 128: 332-343
- Epidemiology, clinical history and microbiology of peritonsillar abscess.Eur J Clin Microbiol Infect Dis. 2015; 34: 549-554
- Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess.Dan Med J. 2017; 64: B5333
- A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation.J Antimicrob Chemother. 2013; 68: 1941-1950
- The association between periodontal disease and peritonsillar infection: a prospective study.J Otolaryngol Head Neck Surg. 2002; 126: 91-94
- Smoking promotes the formation of peritonsillar abscesses.Laryngorhinootologie. 2005; 84 ([in German]): 676-679
- An evidence-based review of peritonsillar abscess.Clin Otolaryngol. 2012; 37: 136-145
- Diagnosis of peritonsillar infections: a prospective study of ultrasound, computed tomography, and clinical diagnosis.J Laryngol Otol. 1999; 113: 229-232
- The management of peritonsillar sepsis by needle aspiration.Clin Otolaryngol. 1991; 16: 245-247
- Treatment of peritonsillar abscess: a prospective study of aspiration vs incision and drainage.Arch Otolaryngol Head Neck Surg. 1987; 113: 984-988
- Diagnosis of peritonsillar abscess: value of intraoral sonography.AJR Am J Roentgenol. 1994; 162: 961-964
- Randomized trial comparing intraoral ultrasound to landmark-based needle aspiration in patients with suspected peritonsillar abscess.Acad Emerg Med. 2012; 19: 626-631
- Intraoral ultrasound evaluation of peritonsillar abscess.Laryngoscope. 1995; 105: 779-782
- Ultrasound guided drainage of peritonsillar abscess by the emergency physician.Am J Emerg Med. 2003; 21: 155-158
- Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department.Acad Emerg Med. 2005; 12: 85-88
- The use of ultrasound imaging in evaluation of peritonsillar infections.Laryngoscope. 2015; 125: 2604-2607
- Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses.Braz J Otorhinolaryngol. 2006; 72: 377-381
- Policy Statement. Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine.(Available at:)
- Think ultrasound first for peritonsillar swelling.Am J Emerg Med. 2015; 33: 569-572
- Thyroid dose from common head and neck CT examinations in children: is there an excess risk for thyroid cancer induction?.Eur Radiol. 2007; 17: 1352-1357
Article info
Publication history
Published online: August 19, 2020
Accepted:
June 1,
2020
Received:
March 31,
2020
Footnotes
Presentations: American College of Emergency Physicians Scientific Assembly, October 27, 2015. Boston, MA; Mediterranean Academy of Emergency Medicine Congress, September 9, 2017. Lisbon, Portugal.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
