Pediatric peritonsillar abscess: Outcomes and cost savings from using transcervical ultrasound
| Autor: | Anjum Bandarkar, William Vintzileos, Brian K. Reilly, Zhen J Huang, Heather Gordish-Dressman |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
business.industry Ultrasound 030208 emergency & critical care medicine Emergency department medicine.disease Logistic regression Surgery 03 medical and health sciences 0302 clinical medicine Phlegmon Otorhinolaryngology Cohort medicine Radiology Peritonsillar Abscess Medical diagnosis 030223 otorhinolaryngology Abscess business |
| Zdroj: | The Laryngoscope. 127:1924-1929 |
| ISSN: | 0023-852X |
| DOI: | 10.1002/lary.26470 |
| Popis: | Objectives 1) To analyze clinical outcomes of children stratified by ultrasound into three diagnoses: acute tonsillitis, peritonsillar phlegmon, and abscess; and 2) To compare clinical outcomes and financial impact between children who underwent ultrasound protocol to those who did not. Study Design Retrospective analysis between two cohorts: ultrasound protocol group and control group. Methods Children with peritonsillar abscess (PTA) diagnosed in the emergency department (ED) were enrolled during a 2-year period for transcervical ultrasound evaluation of bilateral tonsillar fossae. Data from a cohort of patients with PTA prior to ultrasound screening were also collected from retrospective chart review. Outcome variables were analyzed using multivariate logistic regression. Results Seventy-eight children (mean 12.3 years) were enrolled in the ultrasound protocol, compared to 101 children (mean 13.6 years) evaluated using traditional methods of examination and/or computed tomography (CT) imaging. Demographics between the two groups were not significantly different. Only one-third of patients presumed to have PTA by ED staff had ultrasound findings consistent with abscess. Overall treatment failure rate was 8%, requiring readmission or surgical intervention for abscess. Length of stay, surgical drainage, and radiation exposure from CT scans were reduced significantly in the ultrasound group (P < 0.006). Differences in readmission rates and mean charges between the two groups did not reach significance. Conclusion Peritonsillar abscess is a common infection in the pediatric population, but diagnosis can be challenging. Transcervical ultrasound is a safe, cost-effective, and accurate modality to help stratify patients into medical and surgical treatment arms. Level of Evidence 3b. Laryngoscope, 2017 |
| Databáze: | OpenAIRE |
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