Admission avoidance in tonsillitis and peritonsillar abscess
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Fewer patients presented to the emergency department (ED) with tonsillitis and peritonsillar abscess (PTA) during the COVID?19 pandemic. IV antibiotics and steroids given in the ED led to a twofold?threefold increase in the proportion of patients able to swallow, to over 70%. Approximately half of tonsillitis and PTA patients were discharged from the ED, without an increase in later admission.

The objective of this study was to report changes in practice brought about by COVID?19 and the implementation of new guidelines for the management of tonsillitis and peritonsillar abscess (PTA) and to explore factors relating to unscheduled re?presentations for patients discharged from the emergency department (ED).

In this prospective multicentre national audit over 12 weeks adult patients with acute tonsillitis or PTA were included.

--83 centers submitted 765 tonsillitis and 416 PTA cases. 54.4% of tonsillitis and 45.3% of PTAs were discharged from ED. 9.6% of tonsillitis and 10.3% of PTA discharges re?presented within 10 days, compared to 9.7% and 10.6% for those admitted from ED. The subsequent admission rate of those initially discharged from ED was 4.7% for tonsillitis and 3.3% for PTAs.

--IV steroids and antibiotics increased the percentage of patients able to swallow from 35.8% to 72.5% for tonsillitis and from 22.3% to 71.0% for PTA.

--77.2% of PTAs underwent drainage, with no significant difference in re?presentations in those drained vs not?drained.

--Univariable logistic regression showed no significant predictors of re?presentation within 10 days.

Overall, management of tonsillitis and PTA changed during the initial peak of the pandemic, shifting towards outpatient care. Some patients who may previously have been admitted to the hospital may be safely discharged from the ED.

Clinical Otolaryngology