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Published on: November 6, 2019
Clinical factor for successful nonsurgical treatment of pediatric peritonsillar abscess
Dong-Kyu Kim1,2, Jung Woo Lee1, Yoon Sung Na1
1Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea.
Insights
Younger children with smaller peritonsillar abscesses and less recurrent tonsillitis respond better to nonsurgical treatment. Age 7.5 years is a key cutoff for predicting treatment success in pediatric peritonsillar abscess cases.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Surgical Management
Background:
- Peritonsillar abscess management in children often involves antibiotics and surgical drainage.
- Surgical drainage can be challenging in pediatric patients due to anatomical and behavioral factors.
- Identifying predictors for successful nonsurgical treatment is crucial for optimizing pediatric care.
Purpose of the Study:
- To identify factors associated with a favorable response to nonsurgical treatment for peritonsillar abscess in pediatric patients.
- To determine a predictive age cutoff for successful nonsurgical management.
Main Methods:
- Retrospective analysis of 88 pediatric patients with peritonsillar abscess.
- Multivariate logistic regression to identify significant factors.
- Receiver operating characteristic curve analysis to establish an age cutoff.
Main Results:
- Younger age (cutoff 7.5 years), fewer recurrent tonsillitis episodes, and smaller abscess size were significantly associated with good nonsurgical treatment response.
- Adjusted odds ratios indicated the strength of these associations.
- The identified age cutoff demonstrated moderate sensitivity and specificity.
Conclusions:
- Nonsurgical management of pediatric peritonsillar abscess can be successful in select patients.
- Younger age, history of less frequent tonsillitis, and smaller abscess size are key indicators for successful nonsurgical treatment.
- These factors can guide clinical decision-making regarding treatment strategies.
Objectives/Hypothesis:
Current management for peritonsillar abscess in pediatric patients includes intensive medical therapy using antibiotics with or without surgical drainage. However, attaining proper surgical drainage is difficult in young children because they have narrow oral cavities and are less cooperative than adults. The aim of this study was to investigate which factors are associated with a good response to nonsurgical treatment of a pediatric peritonsillar abscess.
Study Design:
A retrospective analysis.
Methods:
This study included consecutive children who visited our pediatric clinic for the treatment of peritonsillar abscess. All patients initially received medical treatment, and additional surgical treatment was provided if the patient appeared unlikely to recover. Multivariate logistic regression models were constructed to identify factors associated with a good response to nonsurgical treatment. In addition, a receiver operating characteristic curve was used to identify the age cutoff for predicting good treatment response.
Results:
A total of 88 children were included the study. Patient age, recurrent tonsillitis, and abscess size were significantly associated with response to nonsurgical treatment (adjusted odds ratios=1.485, 2.403, and 1.325, respectively) after adjusting for sex, body mass index, season, serum C-reactive protein levels, and tonsil grade. The age cutoff associated with good response to nonsurgical treatment was 7.5 years (80.0% sensitivity, 51.5% specificity).
Conclusion:
Our findings suggest that a younger age, fewer episodes of acute tonsillitis, and smaller abscess size predict a successful response to nonsurgical treatment in children with peritonsillar abscess.
Level Of Evidence:
4.
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