Nesemeier Ryan, Jones Shawn, Jacob Kevin, Cash Elizabeth, Goldman Julie
Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Ear Nose Throat J. 2023 Jan;102(1):NP35-NP39. doi: 10.1177/0145561320984996. Epub 2021 Jan 12.
Peritonsillar abscess (PTA) is the most common deep neck space infection and a frequent cause for otolaryngology consultation. Patients often undergo computed tomography (CT) scan for confirmation in addition to physical examination. Our aims were to determine whether patients unnecessarily undergo CT scans in the emergency department (ED) when presenting with sore throat and identify physical examination characteristics that predict PTA.
The electronic medical records of all patients (>18 years) presenting to an ED between June 2014 and June 2015 with a primary diagnosis of acute pharyngitis, acute tonsillitis, or PTA were reviewed for presenting symptoms and diagnostic imaging use.
Four hundred eight patients met inclusion criteria; 21 were diagnosed with PTA, including 13 based on history and physical alone. A total of 21 CT scans were ordered, 11 (52.3%) of which did not demonstrate abscess. Soft palatal fullness, uvular deviation, drooling, and muffled voice were all significantly associated with increased CT usage (all values <.02). Rising subjective pain scores were associated with increased use of CT imaging ( = .029). Multivariable analyses revealed that soft palatal fullness, uvular deviation, and drooling were all significant predictors of PTA (all values <.001).
Patients with severe symptoms of PTA, including uvular deviation, drooling, and soft palatal fullness, were most likely to undergo CT imaging. Given the high likelihood of PTA, patients presenting with these symptoms could forego CT imaging, reducing exposure to ionizing radiation.
扁桃体周围脓肿（PTA）是最常见的深部颈部间隙感染，也是耳鼻喉科会诊的常见原因。除体格检查外，患者通常还需进行计算机断层扫描（CT）以确诊。我们的目的是确定出现咽痛的患者在急诊科（ED）是否不必要地接受了CT扫描，并确定预测PTA的体格检查特征。
回顾了2014年6月至2015年6月期间所有到急诊科就诊、初步诊断为急性咽炎、急性扁桃体炎或PTA的患者（年龄>18岁）的电子病历，以了解其出现的症状和诊断性影像学检查的使用情况。
408例患者符合纳入标准；21例被诊断为PTA，其中13例仅根据病史和体格检查确诊。共开具了21次CT扫描，其中11次（52.3%）未显示脓肿。软腭饱满、悬雍垂偏斜、流涎和声音低沉均与CT检查使用率增加显著相关（所有P值<.02）。主观疼痛评分升高与CT成像检查使用率增加相关（P =.029）。多变量分析显示，软腭饱满、悬雍垂偏斜和流涎均是PTA的显著预测因素（所有P值<.001）。
出现PTA严重症状（包括悬雍垂偏斜、流涎和软腭饱满）的患者最有可能接受CT成像检查。鉴于PTA的可能性很大，出现这些症状的患者可以不进行CT成像检查，从而减少电离辐射暴露。
