Association Between Computed Tomographic Scan and Timing and Treatment of Peritonsillar Abscess in Children

Grant, Maria C.; Guarisco, J. Lindhe

doi:10.1001/jamaoto.2016.2035

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…CT scan might enhance the diagnostic accuracy and avoid unnecessary drainage procedures but there are some limitations which should be taken into consideration [ 40 ]. Grant et al evaluated the CT scan in children with PTA and observed a delay of less-invasive interventions and no influence of the CT scan on the intervention chosen by the clinician [ 41 ]. Furthermore, in 13% of the 3 to 5-year-old children, common anesthesia or sedation was required for CT scan execution enhancing the risk of associated complications [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…Grant et al evaluated the CT scan in children with PTA and observed a delay of less-invasive interventions and no influence of the CT scan on the intervention chosen by the clinician [ 41 ]. Furthermore, in 13% of the 3 to 5-year-old children, common anesthesia or sedation was required for CT scan execution enhancing the risk of associated complications [ 41 ]. Due to the most important disadvantages of additional high costs, the radiation exposure and a specificity of just 50%, the value of the CT scan as an appropriate tool to differentiate between PTA and PC is doubtful.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the most important disadvantages of additional high costs, the radiation exposure and a specificity of just 50%, the value of the CT scan as an appropriate tool to differentiate between PTA and PC is doubtful. Thus, CT scan should be limited to special, isolated cases and not be part of routine PC or PTA management, particularly in children [ 41 ]. Hence, the intraoral and transcutaneous ultrasound of the tonsil and the peritonsillar abscess were established as a cost-efficient and lower-risk method compared to CT scan [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Increased Levels of S100A8/A9 in Patients with Peritonsillar Abscess: A New Promising Diagnostic Marker to Differentiate between Peritonsillar Abscess and Peritonsillitis

et al. 2017

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Peritonsillar abscess (PTA) is a very frequent reason for urgent outpatient consultation and otolaryngological hospital admission. Early, correct diagnosis and therapy of peritonsillar abscess are important to prevent possible life-threatening complications. Based on physical examinations, a reliable differentiation between peritonsillar cellulitis and peritonsillar abscess is restricted. A heterodimeric complex called calprotectin consists of the S100 proteins A8 and A9 (S100A8/A9) and is predominantly expressed not only in monocytes and neutrophils but also in epithelial cells. Due to its release by activated phagocytes at local sites of inflammation, we assumed S100A8/A9 to be a potential biomarker for peritonsillar abscess. We examined serum and saliva of patients with peritonsillitis, acute tonsillitis, peritonsillar abscess, and healthy controls and found significantly increased levels of S100A8/A9 in patients with PTA. Furthermore, we could identify halitosis, trismus, uvula edema, and unilateral swelling of the arched palate to be characteristic symptoms for PTA. Using a combination of these characteristic symptoms and S100A8/A9 levels, we developed a PTA score as an objective and appropriate tool to differentiate between peritonsillitis and peritonsillar abscess with a sensitivity of 92% and specificity of 93%.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Increased Levels of S100A8/A9 in Patients with Peritonsillar Abscess: A New Promising Diagnostic Marker to Differentiate between Peritonsillar Abscess and Peritonsillitis

et al. 2017

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“…Studies have sought to elucidate physical examination findings and characteristic imaging findings to aid in diagnosis. 9,10 Trismus, uvular deviation, and palatal edema, 9 as well as tonsillar asymmetry and muffled voice, 10 are among the most recent reports of clinical findings that are demonstrably statistically significant in their association with PTA, albeit in studies with relatively low statistical power. Considering abscess characteristics on CT scans, 2 Japanese studies demonstrated that PTA is most likely to be found in the intracapsular space and along the superior aspect of the tonsillar pole.…”

Section: Discussionmentioning

confidence: 99%

Association of Computed Tomography With Treatment and Timing of Care in Adult Patients With Peritonsillar Abscess

Carratola

Frisenda²,

Gastañaduy

et al. 2019

TOJ

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Background: Peritonsillar abscess (PTA) is a common occurrence in adult patients, and an important question in such often-seen disease processes is whether we are treating these patients effectively, efficiently, and economically. We sought to determine if a diagnostic computed tomography (CT) scan was associated with a difference in clinical intervention in adult patients with PTA and if CT was associated with delaying this intervention.Methods: We conducted a retrospective case-control study examining therapeutic interventions in adults with PTA. Patients were divided into a control group (those diagnosed without CT, n=159) and a case group (those diagnosed with CT, n=203). Patients were examined for 3 outcomes: admission, bedside procedure (needle aspiration, incision/drainage), and surgical procedure (incision/drainage, tonsillectomy). In addition, we calculated times to admission, otolaryngology consultation, bedside procedure, and surgical procedure.Results: We found a significant association between CT and intervention, with the CT group more likely to be admitted (P< 0.001), the non-CT group more likely to undergo a bedside procedure (P<0.001), and the CT group more likely to undergo operative intervention (P=0.02). Mean times to otolaryngology consultation, admission, and bedside procedure were significantly longer in the CT group than in the non-CT group, determined by calculating the difference of the means with 95% confidence intervals for each comparison (P<0.001).Conclusion: We found that CT scans appear to be useful in the workup and treatment of adult patients with PTA, evidenced by significant differences in interventions between groups with and without CT scans. We also found that CT scans have the potential to delay these interventions, as the time to each intervention examined was significantly longer in patients who had a CT scan. Given the need to reduce cost, enhance efficiency, and eliminate harmful side effects (in this case, radiation exposure and delays in care), we question whether CT is the gold standard imaging method for diagnostic work up of PTA.

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“…There was no association between the use of CT scan and performance of a procedure. 39 We do not recommend routine use of CT scans in this population, as the presentation and physical examination are appropriate for diagnosis.…”

Section: Judicious Use Of Computed Tomography In Pediatricsmentioning

confidence: 95%

Judicious Use of Antibiotics and Radiologic Imaging in Diagnosis and Management of Pediatric Upper Respiratory Tract Infections

Jaggi

2018

J Pediatr Infect Dis

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A considerable amount of effort has been put into the reduction of the overuse of antibiotics and reduction in radiographic studies in the pediatric population. Infections within the ear, nose, and throat and in cervical regions are a frequent source of antibiotic use in children. Quality improvement projects creating clear care pathways have been important to delineate which imaging may be most helpful.

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Association Between Computed Tomographic Scan and Timing and Treatment of Peritonsillar Abscess in Children

Abstract: Use of a CT scan is not associated with a difference in intervention in children with peritonsillar abscesses. It is, however, associated with a clinically significant delay in treatment; namely, time to an otolaryngology consultation, time to admission, and time to bedside procedure.

Cited by 14 publications

References 16 publications

Increased Levels of S100A8/A9 in Patients with Peritonsillar Abscess: A New Promising Diagnostic Marker to Differentiate between Peritonsillar Abscess and Peritonsillitis

Increased Levels of S100A8/A9 in Patients with Peritonsillar Abscess: A New Promising Diagnostic Marker to Differentiate between Peritonsillar Abscess and Peritonsillitis

Association of Computed Tomography With Treatment and Timing of Care in Adult Patients With Peritonsillar Abscess

Judicious Use of Antibiotics and Radiologic Imaging in Diagnosis and Management of Pediatric Upper Respiratory Tract Infections

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