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Diagnosis of Fever Source Following Tonsillectomy and Adenoidectomy in the Pediatric Emergency Department
Nili Yanai Milshtein1, Shir Pres1, Ari Derowe2
1From the Pediatric Emergency Medicine, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Postoperative fever in children after tonsillectomy/adenoidectomy is often pneumonia, not bacterial infection. Chest X-rays are key for diagnosis, while blood tests and specialist consultations offer limited value.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Infectious Diseases
Background:
- Postoperative fever is common in children after tonsillectomy and/or adenoidectomy.
- Identifying the cause of fever is crucial for appropriate management in the pediatric emergency department (ED).
Purpose of the Study:
- To describe the epidemiology and diagnoses of children with postoperative fever.
- To evaluate the diagnostic yield of laboratory tests and otolaryngologist consultations for these patients.
Main Methods:
- Retrospective cohort study of children presenting to a pediatric ED with fever within one week post-tonsillectomy/adenoidectomy.
- Data collected from May 2017 to April 2020.
Main Results:
- 94 patients met criteria; postoperative fever rate was 6% (tonsillectomy/adenoidectomy) and 3% (adenoidectomy alone).
- Pneumonia was the most common cause of fever (diagnosed by chest radiography); bacterial infections were rare (<10%).
- No significant difference in blood test findings between bacterial, viral, or inflammatory causes; no surgical site infections.
Conclusions:
- Pneumonia is the primary cause of fever in children post-tonsillectomy/adenoidectomy, identifiable via chest radiography.
- Routine blood tests and otolaryngologist consultations have limited value in diagnosing fever source in this population.
- Chest radiography can be effectively utilized in outpatient settings for fever evaluation.
Objectives:
This study aimed to describe the epidemiology and diagnoses of children with postoperative fever (a temperature of 38°C or higher) during the week after tonsillectomy and/or adenoidectomy and to assess the yield of the laboratory tests and otolaryngologist consultations of these patients in the pediatric emergency department (ED).
Methods:
We conducted a retrospective cohort study that included all children who presented with fever to the pediatric ED of a tertiary university-affiliated medical center between May 2017 and April 2020 during the week after a tonsillectomy and/or adenoidectomy.
Results:
There were 94 patients who fulfilled study entry criteria during the 3-year study period, representing a 6% rate of postoperative fever for combined tonsillectomy and adenoidectomy and 3% for adenoidectomy alone. Only 9 patients (<10% of the total) were classified as having bacterial infection, whereas the most common cause for the fever was pneumonia diagnosed by chest radiography. None had surgical site infection. There was no significant difference in blood test findings of patients diagnosed with a bacterial infection and patients with a presumed viral infection or an inflammatory response to surgery.
Conclusions:
The results of this investigation revealed that the source of fever of the overwhelming majority of children who were referred to the pediatric ED for fever after undergoing tonsillectomy and/or adenoidectomy was pneumonia as determined by chest radiography, which can be performed in an outpatient setting. Blood tests and otolaryngologist consultations were not contributory in classifying the source of fever, questioning the value of their routine use in these patients.
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