Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates?

OBJECTIVE

To examine trends in hospital admissions for acute throat infection (ATI) and peritonsillar abscess (PTA) alongside tonsillectomy trends in children.

DESIGN

We analysed Hospital Episode Statistics data to calculate annual age-standardised and age-sex specific rates for ATI, PTA and tonsillectomies in children aged 0-17 years who were admitted to hospital in England between 1 April 1999 and 31 March 2010.

RESULTS

Age-standardised admission rates for ATI increased by 76% from 107.3 (95% CI 105.3 to 109.2) to 188.4 (95% CI 185.9 to 191.0) admissions per 100 000 children. Median length of stay for ATI admissions decreased from 1 to 0 days. Admission rates for PTA remained stable at between 9.6 (95% CI 9.0 to 10.2) and 8.7 (95% CI 8.1 to 9.2) per 100 000 children in 1999/2000 and 2009/2010, respectively. Age-standardised tonsillectomy rates declined from 367.4 (95% CI 363.8 to 371.0) to 278.0 (95% CI 274.9 to 281.1) per 100 000 children between 1999/2000 and 2000/2001, respectively, increased to 322.4 (95% CI 319.0 to 325.7) in 2002/2003 and then gradually declined again to 293.6 (95% CI 290.4 to 296.8) in 2009/2010.

CONCLUSIONS

ATI admission rates have increased substantially in the past decade, but the majority of children are discharged after a short stay. PTA admission rates have remained stable. This suggests the severity of throat infection has not increased. Tonsillectomy rates in England have been declining overall but do not appear to be associated with this increasing trend in ATI admissions. The increase most likely reflects changes in primary care and hospital service provision.