Pediatric peritonsillar abscess: transcervical ultrasound linked to faster ED visits

  • Zhao X & al.
  • J Ultrasound Med
  • 11.11.2019

  • von Jenny Blair, MD
  • Clinical Essentials
Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten. Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten.

Takeaway

  • For children with suspected peritonsillar abscess (PTA), the use of transcervical ultrasound was associated with emergency department (ED) visits that were >1 hour shorter vs use of CT. 
  • Authors suggest ultrasound-first diagnostic standard for these patients.

Why this matters

  • Clinical diagnosis of PTA has relatively low sensitivity and low specificity.
  • CT is highly sensitive but irradiating.
  • Intraoral ultrasound may not easily be tolerated, and it can be difficult to clean the transducer.
  • Transcervical and intraoral ultrasound perform similarly to CT for PTA diagnosis.

Key results

  • Patients receiving ultrasound (n=286) vs CT (n=101):
    • Mean length of stay (LOS) in ED, in minutes: 347±145 vs 426±171; absolute difference, 79 (95% CI, 44-113).
    • Difference significant only among patients with negative study result.
    • Return visits within 2 weeks: 8.0% vs 5.9% (P=.66).
  • No patients who received ultrasound required subsequent CT.

Study design

  • Retrospective cohort study at freestanding pediatric hospital (n=387).
  • Authors compared ED LOS before vs after hospital adopted transcervical ultrasound-first protocol for suspected PTA (2009-2013 vs 2013-2017).
  • Funding: None disclosed.

Limitations

  • Nonrandomized single-center before-after study.
  • Radiologists, not emergency physicians, performed ultrasound.