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Original Investigation |

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

Maria C. Grant, MD1,2; J. Lindhe Guarisco, MD2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Tulane University Medical Center, New Orleans, Louisiana
2Department of Otolaryngology–Head and Neck Surgery, Ochsner Medical Center, Jefferson, Louisiana
JAMA Otolaryngol Head Neck Surg. Published online August 11, 2016. doi:10.1001/jamaoto.2016.2035
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Importance  There is not a consensus on the best diagnostic algorithm for children with a potential peritonsillar abscess. The association of computed tomographic (CT) scanning in children with a pertonsillar abscess and intervention chosen by the treating physician, or the potential delay of treatment associated with such imaging, has not yet been explored.

Objectives  To determine if use of a CT scan is associated with a difference in clinical intervention for peritonsillar abscess and to determine if use of a CT scan is associated with delay of this intervention.

Design, Setting, and Participants  A retrospective case-control study examined therapeutic interventions, based on the presence or absence of a diagnostic CT scan, in children diagnosed with peritonsillar abscess from November 1, 2006, to November 1, 2015. Children who presented either to the emergency department or to their pediatrician with a peritonsillar abscess were divided into 2 groups: those diagnosed without the use of a CT scan (controls; n = 38) and those diagnosed with the use of a CT scan (cases; n = 30).

Main Outcomes and Measures  Patients were examined for 2 outcomes: admission or no admission. The groups were also examined for type of intervention performed: bedside procedure (needle aspiration or incision and drainage), surgical procedure in the operating room (needle aspiration, incision and drainage, or tonsillectomy), no procedure, or both bedside and surgical procedure. In addition, the time to an otolaryngology consultation and to each of the above interventions was calculated.

Results  Thirty children underwent a CT scan, while 38 did not. The mean age of children who underwent a CT scan was 14.3 years (range, 3-18 years) and 11.3 years (range, 1-18 years) for those who did not, for an absolute difference of 3 years (95% CI, 0.38-5.62). Among 68 patients (27 boys and 41 girls), there was no significant association between CT scan and admission or between CT scan and type of procedural intervention. However, there was a clinically significant association between CT scan and time to intervention. Mean time to an otolaryngology consultation was 369 minutes in the CT scan group and 63.4 minutes in the control group for an absolute difference of 305.6 minutes (95% CI, 208-404). Mean time to admission was 340 minutes in the CT scan group vs 166 minutes in the control group for an absolute difference of 174 minutes (95% CI, 65.3-283). Mean time to bedside procedure was 493 minutes in the CT scan group compared with 175 minutes in the control group for an absolute difference of 368 minutes (95% CI, 130-606). No significant association was found between use of CT scan and mean time to surgical intervention: mean time to surgical intervention in the CT scan group and the control group was 1.71 days and 1.64 days, respectively, for an absolute difference of 0.06 days (95% CI, –1.54 to 1.66).

Conclusions and Relevance  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.

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Figure.
Time to Otolaryngology Consultation, Admission, and Bedside Procedure

Wilcoxon rank sum scores for time to consultation, time to admission, and time to bedside procedure as measured by the time of initial presentation (P < .05 for all values). The time range to consultation for the computed tomographic (CT) scan group was 1:29-25:40 (hr:min) and for the control group was 0:10-6:59. The time range to admission for the CT scan group was 0:45-19:33 and for the control group was 0:11-6:41. The time range to bedside procedure for the CT scan group was 1:08-25:40 and for the control group was 0:32-9:32. The horizontal line in the middle of each box represents the median. The circles indicate the outliers (in this case, the largest values for time) for each respective category. The horizontal lines surrounding the box plots represent 1.5 × interquartile range.

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