Paediatric peritonsillar abscess: transcervical ultrasound linked to shorter ED visits

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 paediatric 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

• Nonrandomised single-centre before-after study.
• Radiologists, not emergency physicians, performed ultrasound.