Pediatric peritonsillar abscess: Outcomes and cost savings from using transcervical ultrasound

Objectives 1) To analyze clinical outcomes of children stratified by ultrasound into three diagnoses: acute tonsillitis, peritonsillar phlegmon, and abscess; and 2) To compare clinical outcomes and financial impact between children who underwent ultrasound protocol to those who did not. Study Design Retrospective analysis between two cohorts: ultrasound protocol group and control group. Methods Children with peritonsillar abscess (PTA) diagnosed in the emergency department (ED) were enrolled during a 2‐year period for transcervical ultrasound evaluation of bilateral tonsillar fossae. Data from a cohort of patients with PTA prior to ultrasound screening were also collected from retrospective chart review. Outcome variables were analyzed using multivariate logistic regression. Results Seventy‐eight children (mean 12.3 years) were enrolled in the ultrasound protocol, compared to 101 children (mean 13.6 years) evaluated using traditional methods of examination and/or computed tomography (CT) imaging. Demographics between the two groups were not significantly different. Only one‐third of patients presumed to have PTA by ED staff had ultrasound findings consistent with abscess. Overall treatment failure rate was 8%, requiring readmission or surgical intervention for abscess. Length of stay, surgical drainage, and radiation exposure from CT scans were reduced significantly in the ultrasound group ( P < 0.006). Differences in readmission rates and mean charges between the two groups did not reach significance. Conclusion Peritonsillar abscess is a common infection in the pediatric population, but diagnosis can be challenging. Transcervical ultrasound is a safe, cost‐effective, and accurate modality to help stratify patients into medical and surgical treatment arms. Level of Evidence 3b. Laryngoscope , 127:1924–1929, 2017