Utilization of emergency department computed tomography and otolaryngology consultation in the diagnosis of pediatric peritonsillar abscess

Varelas, Antonios; LoSavio, Phillip; Misch, Emily; Casey, Paul; Jeffe, Jill S.

doi:10.1016/j.ijporl.2018.11.034

Cited by 12 publications

(6 citation statements)

References 13 publications

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“…The 19 studies that were excluded due to the small sample size (1-19 patients) presented PPV ranging from 0.40 to 1.00, with a median PPV of 0.90 (IQR 0.83-0.98) [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] (S2 Table ). Including these studies in the meta-analysis, except for the one study with only one patient, did not change the model-based estimate of PPV (0.83, 95% confidence interval 0.79-0.86), but heterogeneity increased (I 2 = 68%, p = 0.011).…”

Section: Plos Onementioning

confidence: 99%

Diagnostic accuracy of contrast-enhanced CT for neck abscesses: A systematic review and meta-analysis of positive predictive value

Hagelberg

Pape²,

Heikkinen³

et al. 2022

PLoS ONE

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Objectives To review the diagnostic accuracy of contrast-enhanced computed tomography (CT) in differentiating abscesses from cellulitis in patients with neck infections, using surgical findings as the reference standard. Materials and methods Previous studies in the last 32 years were searched from PubMed and Embase. Because of partial verification bias (only positive abscess findings are usually verified surgically), sensitivity and specificity estimates are unreliable, and we focused on positive predictive value (PPV). For all studies, PPV was calculated as the proportion of true positives out of all positives on imaging. To estimate pooled PPV, we used both the median with an interquartile range and a model-based estimate. For narrative purposes, we reviewed the utility of common morphological CT criteria for abscesses, such as central hypodensity, the size of the collection, bulging, rim enhancement, and presence of air, as well as sensitivity and specificity values reported by the original reports. Results 23 studies were found reporting 1453 patients, 14 studies in children (771 patients), two in adults (137 patients), and seven including all ages (545 patients). PPV ranged from 0.67 to 0.97 in individual studies, had a median of 0.84 (0.79–0.87), and a model-based pooled estimate of 0.83 (95% confidence interval 0.80–0.85). Most morphological CT criteria had considerable overlap between abscesses and cellulitis. Conclusions The pooled estimate of PPV is 0.83 for diagnosing neck abscesses with CT. False positives may be due to limited soft tissue contrast resolution. Overall, none of the morphological criteria seem to be highly accurate for differentiation between abscess and cellulitis.

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Section: Plos Onementioning

confidence: 99%

Diagnostic accuracy of contrast-enhanced CT for neck abscesses: A systematic review and meta-analysis of positive predictive value

Hagelberg

Pape²,

Heikkinen³

et al. 2022

PLoS ONE

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“…Varelas et al found that otolaryngology consultation reduced the use of CT scans in the setting of pediatric PTA. 32 It is unclear in this study if ED first responders are ordering CTs without consulting otolaryngologists or are doing so under the direction of the consultant. 33…”

Section: Discussionmentioning

confidence: 92%

Trends in Emergency Department Computed Tomography Usage for Diagnosis of Peritonsillar Abscess

et al. 2021

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Objectives: Peritonsillar abscess (PTA) is the most common deep neck space infection and a frequent cause for otolaryngology consultation. Patients often undergo computed tomography (CT) scan for confirmation in addition to physical examination. Our aims were to determine whether patients unnecessarily undergo CT scans in the emergency department (ED) when presenting with sore throat and identify physical examination characteristics that predict PTA. Methods: The electronic medical records of all patients (>18 years) presenting to an ED between June 2014 and June 2015 with a primary diagnosis of acute pharyngitis, acute tonsillitis, or PTA were reviewed for presenting symptoms and diagnostic imaging use. Results: Four hundred eight patients met inclusion criteria; 21 were diagnosed with PTA, including 13 based on history and physical alone. A total of 21 CT scans were ordered, 11 (52.3%) of which did not demonstrate abscess. Soft palatal fullness, uvular deviation, drooling, and muffled voice were all significantly associated with increased CT usage (all P values <.02). Rising subjective pain scores were associated with increased use of CT imaging ( P = .029). Multivariable analyses revealed that soft palatal fullness, uvular deviation, and drooling were all significant predictors of PTA (all P values <.001). Conclusions: Patients with severe symptoms of PTA, including uvular deviation, drooling, and soft palatal fullness, were most likely to undergo CT imaging. Given the high likelihood of PTA, patients presenting with these symptoms could forego CT imaging, reducing exposure to ionizing radiation.

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“…Studies have sought to elucidate physical examination findings and characteristic imaging findings to aid in diagnosis. 9,10 Trismus, uvular deviation, and palatal edema, 9 as well as tonsillar asymmetry and muffled voice, 10 are among the most recent reports of clinical findings that are demonstrably statistically significant in their association with PTA, albeit in studies with relatively low statistical power. Considering abscess characteristics on CT scans, 2 Japanese studies demonstrated that PTA is most likely to be found in the intracapsular space and along the superior aspect of the tonsillar pole.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 While obtaining the maximum benefit from physical examination and CT scan as diagnostic tools is desirable, the question has been raised whether the best imaging modality is something different. 9-11,13…”

Section: Discussionmentioning

confidence: 99%

Association of Computed Tomography With Treatment and Timing of Care in Adult Patients With Peritonsillar Abscess

Carratola

Frisenda²,

Gastañaduy

et al. 2019

TOJ

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Background: Peritonsillar abscess (PTA) is a common occurrence in adult patients, and an important question in such often-seen disease processes is whether we are treating these patients effectively, efficiently, and economically. We sought to determine if a diagnostic computed tomography (CT) scan was associated with a difference in clinical intervention in adult patients with PTA and if CT was associated with delaying this intervention.Methods: We conducted a retrospective case-control study examining therapeutic interventions in adults with PTA. Patients were divided into a control group (those diagnosed without CT, n=159) and a case group (those diagnosed with CT, n=203). Patients were examined for 3 outcomes: admission, bedside procedure (needle aspiration, incision/drainage), and surgical procedure (incision/drainage, tonsillectomy). In addition, we calculated times to admission, otolaryngology consultation, bedside procedure, and surgical procedure.Results: We found a significant association between CT and intervention, with the CT group more likely to be admitted (P< 0.001), the non-CT group more likely to undergo a bedside procedure (P<0.001), and the CT group more likely to undergo operative intervention (P=0.02). Mean times to otolaryngology consultation, admission, and bedside procedure were significantly longer in the CT group than in the non-CT group, determined by calculating the difference of the means with 95% confidence intervals for each comparison (P<0.001).Conclusion: We found that CT scans appear to be useful in the workup and treatment of adult patients with PTA, evidenced by significant differences in interventions between groups with and without CT scans. We also found that CT scans have the potential to delay these interventions, as the time to each intervention examined was significantly longer in patients who had a CT scan. Given the need to reduce cost, enhance efficiency, and eliminate harmful side effects (in this case, radiation exposure and delays in care), we question whether CT is the gold standard imaging method for diagnostic work up of PTA.

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Utilization of emergency department computed tomography and otolaryngology consultation in the diagnosis of pediatric peritonsillar abscess

Cited by 12 publications

References 13 publications

Diagnostic accuracy of contrast-enhanced CT for neck abscesses: A systematic review and meta-analysis of positive predictive value

Diagnostic accuracy of contrast-enhanced CT for neck abscesses: A systematic review and meta-analysis of positive predictive value

Trends in Emergency Department Computed Tomography Usage for Diagnosis of Peritonsillar Abscess

Association of Computed Tomography With Treatment and Timing of Care in Adult Patients With Peritonsillar Abscess

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