Servicio de Otorrinolaringología, Hospital de Requena, Requena, Valencia, Spain.
Servicio de Otorrinolaringología, Consorci Hospital General Universitari de València, Valencia, Spain.
Acta Otorrinolaringol Esp (Engl Ed). 2023 Mar-Apr;74(2):108-115. doi: 10.1016/j.otoeng.2022.04.003. Epub 2023 Mar 9.
This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI).
In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded.
From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases.
The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.
本研究评估了医疗系统过载以及为应对 COVID-19 而做出的组织变革是否会对扁桃体周脓肿(PTI)的临床和流行病学特征产生影响。
在一项回顾性纵向和描述性随访研究中,我们回顾了 2017 年至 2021 年期间在两家医院(一家为区域医院,另一家为三级医院)就诊的患者情况。记录了与基础病理、扁桃体炎病史、疾病进展时间、之前在初级保健机构就诊、诊断发现、脓肿/蜂窝织炎比例以及住院时间等相关的变量。
2017 年至 2019 年,该疾病的发病率在 14 至 16 例/10 万人年之间,2020 年降至 9.3 例,减少了 43%。在大流行期间就诊的 PTI 患者在初级保健机构就诊的频率要低得多。他们的症状更严重,从出现到诊断的时间也更长。此外,脓肿更多,需要住院 24 小时以上的比例为 66%。尽管 66%的患者有反复发作的扁桃体炎病史,71%的患者有合并症,但与急性扁桃体炎几乎没有因果关系,这些发现与大流行前的病例相比具有统计学显著差异。
我国采取的空气传播保护、社交距离和封锁措施似乎能够改变 PTI 的发展进程,使其发病率更低,恢复时间更长,与急性扁桃体炎的关系最小。