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

Background: Peritonsillar abscess (PTA) is the most common infection found in the head and neck. Adolescents and young adults are particularly susceptible to developing PTA. However, clinical impression alone often poorly differentiates between true abscess and acute tonsillitis. Over the last two decades, the introduction of ultrasound in the emergency department (ED) has proven to be an invaluable diagnostic tool that is both highly sensitive and specific. Objective: The first objective was to analyze clinical outcomes of children stratified by ultrasound into three diagnoses: acute tonsillitis, peritonsillar phlegmon, and abscess. The second objective was to compare clinical outcomes and financial impact between children who underwent ultrasound protocol to those who did not. We hypothesized transcervical ultrasound is cost effective for diagnosis and an option for reducing radiation exposure in the pediatric population. Methods: 
 Children with PTA diagnosed in the ED were enrolled during a two year period for transcervical ultrasound evaluation. The ultrasound probe was placed underneath the mandible to visualize appropriate anatomy. Images were then analyzed by a blinded radiologist and categorized as 1) abscess, 2) phlegmon, or 3) tonsillitis. Data from a cohort of patients with PTA who did not receive ultrasound were collected from retrospective chart review. Outcome variables were analyzed using multivariate logistic regression. Results: Seventy-eight children were enrolled in the ultrasound protocol, compared to 101 children evaluated using traditional methods. Only 1/3 of patients presumed to have PTA by ED staff had ultrasound findings consistent with abscess. Overall treatment failure rate was 8% requiring re-admission or surgical intervention for abscess. Length of stay, surgical drainage, and radiation exposure from CT scans were reduced significantly in the ultrasound group (p Conclusions: Based on our findings, the ED was accurate in diagnosing true abscess in only 1/3 of cases. The ...