Management of Peritonsillar Abscess Within a Local Emergency Department: A Quality Analysis Study

Ortega, Briana; Short, Spencer; Kane, Bryan G; Dedio, Robert M.

doi:10.7759/cureus.17545

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Treatment modalities including antibiotics, corticosteroids, and surgical drainage, were similar amongst the two groups. Few patients underwent all three treatment modalities at the initial presentation despite their proven benefits in either shortening recovery time or decreasing complication rates [16]. This data is also similar to the previous literature on the topic where few patients undergo surgical management despite being given corticosteroids and antibiotics [14].…”

Section: Discussionsupporting

confidence: 81%

Analysis of Smoking Behavior in Patients With Peritonsillar Abscess: A Rural Community Hospital's Experience

Clark¹,

Santarelli²,

Merrill³

et al. 2022

Cureus

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BackgroundPeritonsillar abscesses (PTA) are the most common deep space infection of the head and neck. They appear to have an association with a patient's smoking history but data showing this relationship is sparse and controversial. Currently, no data on this association exists for those who seek care at a rural community emergency department (ED). Based upon the lack of data in this setting, the authors sought to determine the incidence, treatments, and outcomes between smokers and non-smokers with a PTA at a rural community ED. MethodsA retrospective chart review of all patients undergoing a soft tissue neck computed tomography (CT) scan with or without intravenous contrast was completed from September 25th, 2019 through October 4th, 2021. Patients with a previously diagnosed PTA and those diagnosed via another means (clinical, needle aspiration, etc.), or outside of the ED were excluded from the dataset. Abstracted data included demographics, treatments, and outcomes of each patient. The data were analyzed using the Mann-Whitney test for continuous data and the chi-square test for categorical data. ResultsDuring the study period, a total of 50 patients were diagnosed with a PTA via soft tissue neck CT. Of those diagnosed, the median age was 40.5 (25.5 -53.3) years, 15 were female, 38 self-identified as white, and 27 noted a current smoking history. Smokers presented to ED earlier than non-smokers (2.0 vs 4.0 days; p=0.03), but no difference was noted in the size of PTA identified via CT (2.0 vs 1.5 cm; p=0.13). No difference among smokers and non-smokers was noted in corticosteroid therapy either administered in the ED (p = 0.53) or prescribed as an outpatient (p = 0.75), incision and drainage (p = 0.19), outpatient follow-up (p = 0.53), or resolution of the symptoms (p = 0.86). However, more patients in the non-smoking group had an unplanned return to the ED as compared to those who smoked (p=0.02). In those patients who were not discharged from the ED after initial presentation, four were admitted to the hospital and 11 were transferred to a higher level of care. ConclusionAlthough drawn from a limited sample from a single rural community ED, a positive smoking history was more common among patients with a PTA. While there was no statistically significant difference in the overall treatment, a difference was noted for unscheduled return visits to the ED in those without a history of smoking.

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Section: Discussionsupporting

confidence: 81%

Analysis of Smoking Behavior in Patients With Peritonsillar Abscess: A Rural Community Hospital's Experience

Clark¹,

Santarelli²,

Merrill³

et al. 2022

Cureus

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“…9 For retropharyngeal abscess, ultrasound can identify the pocket of fluid, a utilization that has mostly been described in pediatrics. 11 This case shows an unexpected complication of needle aspiration. The hematoma shown in Video was monitored using the endocavitary probe to ensure it was not rapidly expanding as pressure was held on the cavity exteriorly.…”

Section: Clinical Practice and Cases In Emergency Medicinementioning

confidence: 83%

Peritonsillar Abscess and Post-aspiration Bleed Identiﬁed with Point-of-care Ultrasound Using Endocavitary Probe: A Case Report

Floyd,

Dahl,

Whited

et al. 2024

Clinical Practice and Cases in Emergency Medicine

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Introduction: Peritonsillar abscesses form between the tonsillar capsule, the superior constrictor, and palatopharyngeus muscles. Physicians traditionally make this diagnosis clinically; however, ultrasound allows clinicians to further identify and differentiate between peritonsillitis, peritonsillar abscess, and phlegmon formation. By increasing both the sensitivity and speciﬁcity, ultrasound improves the diagnostic accuracy for patients with peritonsillar abscesses. This case demonstrates the utilization of ultrasound in peritonsillar abscesses and the application of point-of-care ultrasound (POCUS) in identifying complications of procedures used for treatment in the emergency department (ED).Case Report: A 19-year-old male presented to the ED with complaints of severe sore throat and fever for the prior ﬁve days. A POCUS using an endocavitary probe with sterile cover demonstrated hypoechoic debris with a “swirl sign.” Ultrasound was used to successfully guide needle aspiration by using in-plane needle guidance. The patient had signiﬁcant bleeding after needle aspiration, and repeat POCUS clearly identiﬁed a new pocket of blood that had formed and was contained in the soft tissue. We monitored the size of the hematoma in real time with ultrasound to ensure the hematoma had no rapid expansion and was stable.Conclusion: Among the differential diagnoses for sore throat, the diagnosis of peritonsillar abscess is particularly concerning as it is both common and generally requires swift intervention. Presentations can range from a mild infection to a life-threatening emergency with potential airway compromise. The two primary avenues for treatment include either needle aspiration or incision and drainage. Ultrasound can successfully identify the abscess and other landmarks for safe and successful drainage, as well as early identiﬁcation of complications.

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“…A treatment path based on best care guidelines allows for appropriate care of PTA patients and has downstream consequences in terms of resource utilization and patient care [12]. Management plans learned during residency are highly variable and may leave EM feeling ill-equipped to perform PTA, including which patients would benefit from either aspiration or I&D versus medical management [13].…”

Section: Discussionmentioning

confidence: 99%

Management Protocol for Uncomplicated Peritonsillar Abscess: Standardizing Care and Improving Emergency Medicine Resident Confidence

Casey,

Keidel,

Kudo

et al. 2024

Cureus

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Introduction: A peritonsillar abscess (PTA) is a frequent reason for a visit to the emergency department. As there are no current published guidelines for medical versus surgical management, attending physicians vary among management tendencies, generating uncertainty among resident physicians. This project established a standard of care for managing patients with PTA and provided clear management guidelines to the emergency department, in collaboration with the otolaryngology department, at a community academic hospital. Methods: Pre- and post-interventional, anonymous surveys were given to assess resident physician confidence in the management of PTA. A proposed management protocol was developed based on existing literature and approved by both the emergency medicine (EM) and otolaryngology (ENT) departments. The protocol was then disseminated during in-person didactic sessions to EM residents and ENT residents for use over a four-month interventional period. Results: The mean confidence level for all residents increased significantly after the implementation of the protocol (p<0.001). The increase in confidence level for “antibiotic selection for PTA” (p=0.72) and “inpatient PTA management” (p=0.20) was not statistically significant for the post-graduate year (PGY) 3 and 4 residents. The increase in confidence level was higher overall for PGY 1 and 2 residents (95% CI 2.25 ± 1.09, p<0.001) than for PGY 3 and 4 residents (95% CI 1.73 ± 1.09, p=0.003). Conclusion: The implementation of a standardized protocol for the management of PTA proved to be an effective tool in assisting residents and improving their confidence. This study highlights the importance of establishing guidelines in clinical practice to promote consistent and evidence-based management strategies for PTA. By providing clear guidelines, this protocol enhances communication among healthcare providers and contributes to the delivery of high-quality care to patients with PTA.

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Management of Peritonsillar Abscess Within a Local Emergency Department: A Quality Analysis Study

Abstract: Ortega et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 5 publications

References 12 publications

Analysis of Smoking Behavior in Patients With Peritonsillar Abscess: A Rural Community Hospital's Experience

Analysis of Smoking Behavior in Patients With Peritonsillar Abscess: A Rural Community Hospital's Experience

Peritonsillar Abscess and Post-aspiration Bleed Identiﬁed with Point-of-care Ultrasound Using Endocavitary Probe: A Case Report

Management Protocol for Uncomplicated Peritonsillar Abscess: Standardizing Care and Improving Emergency Medicine Resident Confidence

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