Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
University of Missouri School of Medicine, Degree Program, Columbia, MO, USA.
Am J Emerg Med. 2021 Dec;50:739-743. doi: 10.1016/j.ajem.2021.09.063. Epub 2021 Sep 25.
The goal of this study was to determine if computed tomography (CT) added any clinical information that was incorporated into the decision regarding treatment for patients who presented to the Emergency Department (ED) with sore throat.
A retrospective chart review of adult patients who presented to the ED with a chief complaint of sore throat who subsequently underwent CT during that ED visit between 1/1/18 and 12/31/18 at our tertiary academic health center was performed. The association between palatal bulge on Otolaryngology physical exam with successful drainage procedure was examined. The mean Hounsfield units (HU) and maximum dimension of measurable fluid collection on CT were compared between patients who underwent a successful drainage procedure and those who did not undergo a drainage procedure or attempted drainage was unsuccessful.
Ninety-four patients met inclusion criteria, with 53% (50/94) men. Of the 22 patients with a palatal bulge on physical examination by Otolaryngology, 86% (19/22) underwent a successful drainage procedure (p < 0.001) when compared to those not undergoing successful drainage. Notably, 56% (53/94) of CT scans were interpreted as normal or tonsillitis. The mean HU was 42.0 in those patients who underwent a successful drainage procedure and 74.1 in those who did not undergo a drainage procedure (p < 0.001). Overall, 21/35 fluid collections had a palatal bulge (p < 0.001).
Palatal bulge is a reliable finding in identifying patients with a drainable peritonsillar abscess, and CT scans could largely be avoided in patients without physical exam findings suggestive of more extensive deep neck space abscesses. If a CT scan is obtained, HU should be measured and incorporated into the shared decision-making process with the patient.
本研究旨在确定计算机断层扫描（CT）是否为因咽痛至急诊科就诊的患者提供了可纳入治疗决策的临床信息。
回顾性分析了 2018 年 1 月 1 日至 12 月 31 日期间在我们的三级学术医疗中心，因咽痛就诊的成年患者的病历，这些患者在急诊科就诊期间行 CT 检查。检查耳鼻喉科体格检查中软腭膨隆与成功引流术之间的关联。比较 CT 上可测量积液的平均亨氏单位（HU）和最大尺寸，比较行成功引流术与未行引流术或引流术不成功的患者。
94 名患者符合纳入标准，其中 53%（50/94）为男性。耳鼻喉科体格检查发现软腭膨隆的 22 名患者中，86%（19/22）行成功引流术（p<0.001），而未行引流术的患者中，86%（19/22）行成功引流术。值得注意的是，56%（53/94）的 CT 扫描结果为正常或扁桃体炎。行成功引流术的患者 HU 平均值为 42.0，未行引流术的患者 HU 平均值为 74.1（p<0.001）。总体而言，35 个积液中有 21 个（p<0.001）存在软腭膨隆。
软腭膨隆是鉴别可引流的扁桃体周围脓肿患者的可靠指标，对于无体格检查提示更广泛的深部颈间隙脓肿的患者，可基本避免行 CT 检查。如果行 CT 检查，应测量 HU 值并纳入与患者的共同决策过程中。
