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POCUS for Peritonsillar Abscess

May 14, 2021

Written by Lindsay Taylor, MD, FACEP, SAEM-AEUS

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Point of care ultrasound (POCUS) provides safer, more accurate, and more efficient patient care for the diagnosis and management of peritonsillar abscess (PTA).

Why does this matter?
Common physical exam findings of a PTA include a “hot potato” voice, pharyngeal erythema, and asymmetric edema, causing deviation of the uvula to the contralateral side.  Despite these classic findings, the physical exam only has a sensitivity of 78% and a specificity of 50%, and if a patient has trismus, this may be worse.  Conventional diagnosis is made using physical exam and/or computed tomography (CT) of the neck, and management involves blind, landmark-based aspiration or I&D. The traditional diagnosis and management of PTAs puts your patients at increased risk for complications and exposes them to radiation.

Don’t play hot potato with your patient’s PTA when you have POCUS
The authors did a retrospective cohort study on the diagnosis and management of patients who presented to the ED with PTA. They reviewed two cohorts of patients: cohort one presented between January 2007 and December 2008 (48 patients), and cohort two presented between January 2013 and December 2014 (114 patients). The data from these cohorts was further divided into patients whose diagnosis and management included POCUS vs. no ultrasound (NUS).

The primary endpoint was POCUS utilization, and the secondary endpoints included: successful aspiration, otolaryngology (ENT) consultation, computed tomography (CT) imaging, unscheduled return visits, and length of stay (LOS). The Fisher’s exact and t-tests analyzed data.

Twelve patients in cohort 1 had a POCUS (25%) vs. 89 in cohort 2 (78%) (p < 0.0001; odds ratio [OR] 0.09 (95% confidence interval [CI] 0.04–0.20).  The secondary endpoints of the combined cohorts are listed in study table 3.

From cited article

Use of POCUS for PTAs has significantly increased since 2007 at the study institution. The data also demonstrates that it improves aspiration success and decreases consultations, radiation exposure, return visits, and ED LOS.  For your next hot potato, consider using POCUS to help cool it off.

Evidence-Based Medicine Improves the Emergent Management of Peritonsillar Abscesses Using Point-of-Care Ultrasound. J Emerg Med. 2020 Nov;59(5):693-698. doi: 10.1016/j.jemermed.2020.06.030. Epub 2020 Aug 19.

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