Impact of Bedside Ultrasound on Emergency Department Length of Stay and Admission in Patients With a Suspected Peritonsillar Abscess

Abstract

IntroductionPatients presenting to the Emergency Department (ED) with a suspected peritonsillar abscess (PTA) often pose a diagnostic dilemma, as clinical impression is often unreliable and traditional diagnostic methods have multiple downsides. Bedside ultrasonography has been cited as a modality to improve the diagnosis and management of PTA. We aimed to determine the impact bedside ultrasound (US) could have in suspected PTA on ED length of stay (LOS) and hospital admission rates. MethodsWe performed a retrospective chart review on patients who presented to the ED with suspected ''peritonsillar abscess''. ResultsFrom a sample of 58 charts, seven had documented bedside US performed. The average ED length of stay for these seven cases was 160 minutes (range: 52 to 270 minutes). The ED length of stay for all other cases utilizing other diagnostic methods during the same time period was 293 minutes (range: 34 to 780 minutes). None of the patients who were diagnosed with US were admitted to the hospital, whereas 36.4% of patients where US was not used were admitted. ConclusionThe use of bedside US in seven cases of suspected PTA had reduced LOS in the ED and none required hospital admission.

Management Protocol for Uncomplicated Peritonsillar Abscess: Standardizing Care and Improving Emergency Medicine Resident Confidence

“…Intraoral ultrasound in the ED is increasingly being utilized as a management tool to guide interventions. This point-of-care tool has the potential to reduce the length of stay and need for admission in select patients presenting with PTA [ 9 , 10 ].…”

The Use of Point of Care Ultrasound in Diagnosis of Peritonsillar Abscess

“…POCUS has increasingly been used as an adjunct for diagnosis of PTA, with a sensitivity ranging from 89-95% and specificity of 78-100% 3 , 5 . Additionally, when used for the treatment of PTA, POCUS increases successful drainage and diagnostic accuracy, and decreases otolaryngology consultation, CT utilization, return visits to the ED, and length of stay 1 , 6 , 7 . In our case, PTA was rapidly diagnosed and successfully treated in the ED without the need for otolaryngology consultation or CT.…”

Diagnostic possibilities in peritonsillar abscess and the significance of transcutaneous ultrasound - Systematic Review of the Literature

“…[19] The utilization of ultrasound in emergency medicine for diagnostic purposes has the potential to decrease hospital admissions. [20] However, it is essential to highlight the limitations of ultrasound, which may require the use of secondary imaging and potentially extend hospital stays. [21] In response to this challenge, the introduction of Contrast-Enhanced Ultrasound (CEUS) proves beneficial by not only diminishing the reliance on secondary imaging by enhancing the sensitivity of ultrasound.…”