Peritonsillar Abscess Outcomes with and Without Computed Tomography: A Retrospective Cohort Study

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Infectious Diseases

Background:

• Peritonsillar abscess (PTA) is a common deep neck infection.
• Diagnosis can be made clinically or with computed tomography (CT).
• CT may lead to overdiagnosis and unnecessary interventions, while clinical diagnosis risks missing treatable abscesses.

Purpose of the Study:

• To evaluate the utility and impact of CT scans in diagnosing suspected peritonsillar abscess (PTA).
• To compare patient outcomes between those diagnosed with PTA with and without CT imaging.

Main Methods:

• Retrospective cohort analysis of patients with suspected PTA using TriNetX datasets.
• Comparison of outcomes between PTA patients with CT imaging versus those without CT.
• Measured outcomes included rates of incision and drainage, adenotonsillectomy, recurrent PTA, airway emergencies, repeat ED visits, and medication use (antibiotics, opiates, steroids).

Main Results:

• Patients diagnosed with PTA using CT showed increased odds of receiving antibiotics (OR 3.043), opiates (OR 1.614), and steroids (OR 1.373).
• The CT group also had higher likelihoods of returning to the emergency department (ED) (OR 5.900) and experiencing recurrent PTA (OR 1.943).
• No significant differences were found in rates of surgical drainage, adenotonsillectomy, or airway obstruction between the groups.

Conclusions:

• CT scan utilization in peritonsillar abscess (PTA) diagnosis correlates with increased prescriptions for antibiotics, opioids, and steroids.
• CT use was also associated with higher rates of emergency department revisits and recurrent PTA.
• Further prospective studies are warranted to ascertain if higher patient acuity in CT-diagnosed cases explains these observed negative outcomes.