Use of Computed Tomography in the Emergency Department for the Diagnosis of Pediatric Peritonsillar Abscess

and §Division of Emergency Medicine, Children's Mercy Hospital and Clinics, Kansas City, MO.
Pediatric emergency care (Impact Factor: 1.05). 09/2012; 28(10):962-5. DOI: 10.1097/PEC.0b013e31826c6c36
Source: PubMed


The objective of this study was to review our pediatric emergency department's (ED's) utilization of computed tomography (CT) in the diagnosis of peritonsillar abscess (PTA) and treatment outcomes.
This study used case series with chart review.
From January 2007 to January 2009, 148 patients were seen in our ED for possible PTA. Mean age at presentation was 11.8 years (range, 10 months to 18 years); 81 (54.7%) of 148 were females. Computed tomography was ordered in 96 (64.9%) of 148 patients, of which 73 (49.3%) 148 were confirmed to have PTA. Mean age of patients who underwent CT was younger when compared with those who did not have CT performed (mean, 11 vs 13 years; P = 0.02). Unilateral PTA was found in 65 (43.9%) of 148, bilateral in 8 (5.4%) of 148, and intratonsillar in 25 patients (16.9%). Concomitant CT findings of parapharyngeal space involvement were found in 19 (12.8%), and retropharyngeal space involvement in 11 (7.4%). Admission was necessary for 104 (71.2%) of 148 patients, whereas 42 were discharged from the ED. Transoral needle aspiration and/or incision and drainage were performed in the ED in 41 patients, with purulence identified in 33 (80.5%) of 41. Rapid strep testing was positive in 40 (32%) of 124 patients tested. Operative treatment was necessary in 44 patients (29.7%), 34 underwent incision and drainage, and 10 underwent quinsy tonsillectomy.
Computed tomography is commonly utilized in the ED for the evaluation of PTA and is ordered more often in younger children.

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    ABSTRACT: Current management for peritonsillar abscess in pediatric patients includes intensive medical therapy using antibiotics with or without surgical drainage. However, attaining proper surgical drainage is difficult in young children because they have narrow oral cavities and are less cooperative than adults. The aim of this study was to investigate which factors are associated with a good response to nonsurgical treatment of a pediatric peritonsillar abscess. A retrospective analysis. This study included consecutive children who visited our pediatric clinic for the treatment of peritonsillar abscess. All patients initially received medical treatment, and additional surgical treatment was provided if the patient appeared unlikely to recover. Multivariate logistic regression models were constructed to identify factors associated with a good response to nonsurgical treatment. In addition, a receiver operating characteristic curve was used to identify the age cutoff for predicting good treatment response. A total of 88 children were included the study. Patient age, recurrent tonsillitis, and abscess size were significantly associated with response to nonsurgical treatment (adjusted odds ratios = 1.485, 2.403, and 1.325, respectively) after adjusting for sex, body mass index, season, serum C-reactive protein levels, and tonsil grade. The age cutoff associated with good response to nonsurgical treatment was 7.5 years (80.0% sensitivity, 51.5% specificity). Our findings suggest that a younger age, fewer episodes of acute tonsillitis, and smaller abscess size predict a successful response to nonsurgical treatment in children with peritonsillar abscess. 4. Laryngoscope, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
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