Voruz François, Revol Rebecca, Combescure Christophe, Monnier Yan, Becker Minerva, Dulguerov Nicolas
Department of Clinical Neurosciences, Clinic of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland.
Department of Health and Community Medicine, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland.
Diagnostics (Basel). 2025 Jan 20;15(2):228. doi: 10.3390/diagnostics15020228.
Peritonsillar abscess (PTA) is relatively common but challenging to diagnose clinically. Several clinical signs may be used, with unknown performances. We evaluated and compared the diagnostic performance of individual and combined clinical signs (, , , , , and ) assessed by an otolaryngologist and of contrast-enhanced computed tomography (CT) to detect acute PTA. Prospective study in 133 consecutive adult patients (77 males, mean age = 33 years) with suspected clinical PTA and CT obtained in the emergency setting of a tertiary care hospital between November 2020 and October 2022. The standard of reference consisted of surgically proven pus within 24 h of CT or a favorable clinical evolution at 48 h without surgical intervention. PTA was present in 117/133 (88%) patients, with no difference between mean age or sex distribution between the groups with and without PTA. None of the evaluated clinical signs were associated with PTA (OR = 1.26-5.43, > 0.05), whereas the CT finding "abscess" was significantly associated with PTA (OR = 67.2, < 0.0001). The sensitivity of individual clinical signs varied between 19.7% and 73.5%, and the sensitivity of CT was significantly higher for all clinical signs (95.7%, < 0.0001) except for (97.4%, = 0.7266). The specificity of clinical signs varied between 12.5% and 93.8%, and the specificity of CT was significantly higher (75%, < 0.05) for and . All clinical signs together yielded an area under the curve (AUC) = 0.677. In adults, clinical assessment alone using independent clinical signs and overall clinical impression does not allow a reliable diagnosis of PTA, even when performed by an otolaryngologist. CT is reliable in diagnosing PTA and, whenever available, should be the examination method of choice for diagnosing PTA, especially by a non-specialist.
扁桃体周围脓肿（PTA）相对常见，但临床诊断具有挑战性。可使用多种临床体征，但其表现尚不清楚。我们评估并比较了由耳鼻喉科医生评估的单个及联合临床体征（、、、、、和）以及对比增强计算机断层扫描（CT）检测急性PTA的诊断性能。对2020年11月至2022年10月期间在一家三级护理医院急诊科就诊的133例连续成年疑似临床PTA患者（77例男性，平均年龄 = 33岁）进行前瞻性研究，并进行CT检查。参考标准包括在CT检查后24小时内手术证实有脓液，或在48小时内临床病情好转且无需手术干预。133例患者中有117例（88%）存在PTA，有PTA组和无PTA组之间的平均年龄或性别分布无差异。所评估的临床体征均与PTA无关（OR = 1.26 - 5.43，> 0.05），而CT表现“脓肿”与PTA显著相关（OR = 67.2，< 0.0001）。单个临床体征的敏感性在19.7%至73.5%之间，除（97.4%，= 0.7266）外，CT对所有临床体征的敏感性均显著更高（95.7%，< 0.0001）。临床体征的特异性在12.5%至93.8%之间，CT对和的特异性显著更高（75%，< 0.05）。所有临床体征综合得出的曲线下面积（AUC） = 0.677。在成年人中，即使由耳鼻喉科医生进行，仅使用独立临床体征和总体临床印象进行临床评估也无法可靠诊断PTA。CT在诊断PTA方面可靠，只要可行，应是诊断PTA的首选检查方法，尤其是对于非专科医生而言。
