Risk factors for peritonsillar abscess in streptococcus A-negative tonsillitis: a case control study.

Area of Science:

• Otolaryngology
• Infectious Diseases
• Clinical Decision Making

Background:

• Centor criteria and FeverPAIN score are recommended for tonsillitis antibiotic guidance but lack validation.
• Peritonsillar abscess (PTA) is a complication of tonsillitis.

Purpose of the Study:

• Identify risk factors for PTA in group A Streptococcus-negative tonsillitis.
• Evaluate the performance of clinical scores and lab tests in predicting PTA.

Main Methods:

• Retrospective case-control study (Jan 2015-June 2018) with propensity score matching.
• Included 141 PTA cases and 282 controls, excluding patients under 18, with positive tests, or refusal.
• Logistic regression analysis identified risk factors.

Main Results:

• Higher Centor score, CRP, and WBC were associated with PTA but had low predictive performance (ROC AUC 0.76).
• FeverPAIN score was not associated with PTA (ROC AUC 0.51).
• Significant risk factors for PTA included difficulty swallowing, dyspnea, tonsillar swelling, and unilateral signs (ORs ranging from 4.21 to 522).

Conclusions:

• Centor criteria, CRP, WBC, and FeverPAIN score have low discriminatory performance for PTA in this patient group.
• New decision tools incorporating symptoms like difficulty swallowing, dyspnea, tonsillar swelling, and unilaterality are needed for rational antibiotic prescription.