Analysis of Smoking Behavior in Patients With Peritonsillar Abscess: A Rural Community Hospital's Experience

Background Peritonsillar abscesses (PTA) are the most common deep space infection of the head and neck. They appear to have an association with a patient's smoking history but data showing this relationship is sparse and controversial. Currently, no data on this association exists for those who seek care at a rural community emergency department (ED). Based upon the lack of data in this setting, the authors sought to determine the incidence, treatments, and outcomes between smokers and non-smokers with a PTA at a rural community ED. Methods A retrospective chart review of all patients undergoing a soft tissue neck computed tomography (CT) scan with or without intravenous contrast was completed from September 25th, 2019 through October 4th, 2021. Patients with a previously diagnosed PTA and those diagnosed via another means (clinical, needle aspiration, etc.), or outside of the ED were excluded from the dataset. Abstracted data included demographics, treatments, and outcomes of each patient. The data were analyzed using the Mann-Whitney test for continuous data and the chi-square test for categorical data. Results During the study period, a total of 50 patients were diagnosed with a PTA via soft tissue neck CT. Of those diagnosed, the median age was 40.5 (25.5 - 53.3) years, 15 were female, 38 self-identified as white, and 27 noted a current smoking history. Smokers presented to ED earlier than non-smokers (2.0 vs 4.0 days; p=0.03), but no difference was noted in the size of PTA identified via CT (2.0 vs 1.5 cm; p=0.13). No difference among smokers and non-smokers was noted in corticosteroid therapy either administered in the ED (p = 0.53) or prescribed as an outpatient (p = 0.75), incision and drainage (p = 0.19), outpatient follow-up (p = 0.53), or resolution of the symptoms (p = 0.86). However, more patients in the non-smoking group had an unplanned return to the ED as compared to those who smoked (p=0.02). In those patients who were not discharged from the ED after initial presentation, four were admitted to the hospital and 11 were transferred to a higher level of care. Conclusion Although drawn from a limited sample from a single rural community ED, a positive smoking history was more common among patients with a PTA. While there was no statistically significant difference in the overall treatment, a difference was noted for unscheduled return visits to the ED in those without a history of smoking.