Evidence-Based Medicine Improves the Emergent Management of Peritonsillar Abscesses Using Point-of-Care Ultrasound

Background

Physical examination for peritonsillar abscess (PTA) has limited sensitivity. Traditional management involves blind needle aspiration, which has a false negative rate of 10–24%. A randomized controlled trial by Costantino et al. demonstrated that point-of-care ultrasound (POCUS) improves PTA management.

Objectives

Compare the use and impact of POCUS between patient cohorts prior to and after the trial by Costantino et al.

Methods

Retrospective cohort study of adult patients diagnosed with PTA. Cohort 1 presented to the emergency department (ED) January 2007–December 2008. Cohort 2 presented between January 2013 and December 2014. Data were separated into those with POCUS vs. without ultrasound (NUS). Primary endpoint was POCUS utilization. Secondary endpoints were successful aspiration, otolaryngology (ear, nose, and throat [ENT]) consultation, computed tomography (CT) imaging, unscheduled return visits, and length of stay (LOS). The Fisher’s exact and t -tests analyzed data.

Results

Cohort 1 enrolled 48 patients, vs. 114 patients for cohort 2. Twelve patients in cohort 1 had a POCUS (25%) vs 89 in cohort 2 (78%) ( p < 0.0001; odds ratio [OR] 0.09 (95% confidence interval [CI] 0.04–0.20). Emergency physician (EP) successful aspiration: 89.1% POCUS vs. 24.5% NUS ( p < 0.0001; OR 25 [95% CI 10–59]). Combined EP/ENT successful aspiration: 99.0% POCUS vs. 80.3% NUS ( p < 0.0001; OR 24 [95% CI 3–193]). ENT consultation:12.9% POCUS vs. 65.6% NUS ( p < 0.0001; OR 0.07 [95% CI 0.03–0.17]). CT usage: 23.8% POCUS vs. 37.7% NUS ( p = 0.07; OR 0.51 [95% CI 0.25–1.02]). Return visits: 3.96% POCUS vs. 18.0% NUS ( p = 0.004; OR 0.18 [95% CI 0.05–0.61]).

Conclusion

POCUS use has increased for PTA treatment, improves aspiration, and decreases consultations, CTs, return visits, and LOS.

למאמר המלא   pocus PERITONSILLAR ABSCESSES