International Journal of Pediatric Otorhinolaryngology 125 (2019) 32–37

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International Journal of Pediatric Otorhinolaryngology

journal homepage: www.elsevier.com/locate/ijporl

Trends in the management of peritonsillar abscess in children: A nationwide T

population-based study in Taiwan
Chia-Hsuan Leea,b,c, Wei-Chung Hsub,d, Jenq-Yuh Kob,d, Te-Huei Yehb,d, Kun-Tai Kanga,b,∗
a
Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
b
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
c
Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
d
Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan

A R T I C LE I N FO A B S T R A C T

Keywords: Objective: Population-based studies analyzing peritonsillar abscess in children are lacking. In this study, a po-
Child pulation-based survey of the epidemiology of pediatric peritonsillar abscess in Taiwan was conducted.
Disease management Methods: This cross-sectional study was conducted using the Taiwan National Health Insurance Research
Epidemiology Database. All cases of inpatient pediatric peritonsillar abscess (age < 18 years) in Taiwan between 2000 and
Inpatients
2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification.
Peritonsillar abscess
Incidence rates of inpatient peritonsillar abscess in children were calculated. Characteristics such as age, gender,
hospital level, treatment modalities, imaging studies, drug administration, and length of hospital stays during
the study period were analyzed.
Results: A total of 12,965 children with peritonsillar abscess were included (mean age, 6.6 years [standard
deviation, 4.8 years]; 56.5% boys). The overall incidence was 18 per 100,000 children. Incidence rates decreased
from 2000 to 2012 (19.1/100,000 to 8.3/100,000 children) (ptrend < 0.001). During the study period, the
proportion of peritonsillar abscess treatments at medical centers increased from 4.6% to 15.0%. The proportion
of treatments involving incision and drainage or needle aspiration increased significantly (1.3%–4.1% and
49.4%–65.6%, respectively), whereas treatments with antibiotics only decreased significantly (48.9%–29.0%).
The use of computed tomography (CT) increased (1.4%–12%, ptrend < 0.001). The use of nonsteroidal anti-
inflammatory drugs, steroids, and penicillin increased during the study period. The mean length of hospital stays
increased from 3.78 to 4.67 days.
Conclusions: The incidence of peritonsillar abscess in children decreased between 2000 and 2012 in Taiwan.
Moreover, increasing trends were observed in the use of CT, the rates of incision and drainage and needle
aspiration procedures, and the length of hospital stay in this study cohort.

1. Introduction management in severe or complicated cases [6]. However, in pediatric

Peritonsillar abscess is an acute infection with pus accumulation in
the peritonsillar space, which is located between the capsule of the
palatine tonsil and the muscle of the pharynx [1,2]. Peritonsillar ab-
scess remains one of the most common infections in the head and neck
region [3], and the diagnosis of this condition is usually made on the
basis of clinical symptoms (e.g. such as fever, sore throat, and dys-
phagia) and a physical examination (e.g. trismus and a muffled voice)
[1,2]. Currently, management of peritonsillar abscess in children is
toward drainage or at least needle aspiration is the strongly preferred
management [4,5]. Hospitalization may be required for adequate
patients, management of peritonsillar abscess is challenging because of
the relatively small airways in these patients and their inability to co-
operate during examination and treatment [7,8].
Management of pediatric peritonsillar abscess has been reported to
evolve gradually [9–11]. No consensus has been reached regarding the
appropriate management of peritonsillar abscess in the pediatric po-
pulation [12,13]. Evidence-based reviews by Johnson et al., in 2003
and Powell et al., in 2012 have indicated that needle aspiration and
incision as well as drainage may be equally effective in the treatment of
peritonsillar abscess [14,15]. A national report by Qureshi et al. showed
a significant increase in the rate of incision and drainage procedures

∗
Corresponding author. Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, No.127, Siyuan Rd, Xinzhuang Dist., New Taipei City,
Taiwan.
E-mail address: kang.kuntai@msa.hinet.net (K.-T. Kang).

https://doi.org/10.1016/j.ijporl.2019.06.016
Received 13 April 2019; Received in revised form 16 June 2019; Accepted 16 June 2019
Available online 20 June 2019
0165-5876/ © 2019 Elsevier B.V. All rights reserved.
C.-H. Lee, et al. International Journal of Pediatric Otorhinolaryngology 125 (2019) 32–37

and no change in the rates of surgical intervention and length of hos-
pital stay for pediatric inpatients with peritonsillar abscess from 2000
to 2009 in the United States [11]. However, a national consensus on the
treatment of peritonsillar abscess is not currently available. Therefore,
population-based surveys on peritonsillar abscess among children are
highly necessary.
Taiwan's National Health Insurance (NHI) was established in 1995,
and provides coverage for 99% of Taiwan's 23 million inhabitants
[16,17]. The NHI Research Database (NHIRD) is a medical claims da-
tabase of the entire insured population [18]. The NHIRD allows clin-
icians to conduct population-based epidemiological analysis of diseases
and procedures [19–23]. Using data from the NHIRD, all pediatric in-
patients with peritonsillar abscess from 2000 to 2012 were identified.
In this study, we conducted a population-based analysis to clarify the
epidemiology and trends related to peritonsillar abscess in pediatric
inpatients in Taiwan.
2. Materials and methods
This study was approved by the Ethics Committee of Taipei
Hospital, Ministry of Health and Welfare, Taiwan (IRB No. TH-IRB-
0017-0024) and was exempted from the requirement to obtain in-
formed consent from individuals because the profiles in the NHIRD are
deidentified.
2.1. Database and patient identification
This study was designed as a nationwide population-based cross-
section study by using the Taiwan NHIRD, which as a coverage rate of
99.8%. The study cohort included patients aged < 18 years who were
admitted for the first time for peritonsillar abscess between 2000 and
2012. All the hospitalized children who had received treatment for
peritonsillar abscess were identified using the International
Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-
CM) diagnosis code 475. The date of admission for peritonsillar abscess
unit (ICU) during admission were identified. The number of hospitali-
zation days of each child was calculated. The aforementioned events
were identified from the inpatient claims data and were further ana-
lyzed.
2.4. Statistical analysis
The incidence of peritonsillar abscess was estimated using the total
number of peritonsillar abscess events per 100,000 population. The
trend in the incidence of peritonsillar abscess across the study years was
examined using a univariate Poisson regression model in which the
study year was a continuous explanatory variable and the logarithm of
the mid-year population in Taiwan was an offset variable. The trend in
the proportions of categorical variables (e.g., medical center, gender,
and drug administration) across the study years was tested using a
univariate logistic regression analysis. The trend in the values of con-
tinuous variables (e.g., age and admission days) across the study years
was tested using univariate linear regression analysis. A two-sided p
value of < 0.05 was considered statistically significant, and no adjust-
ment for multiple testing (multiplicity) was made. Data management
and statistical analyses were performed using SAS version 9.4 (SAS
Institute, Cary, NC)
3. Results
3.1. Study population
A total of 12,965 children who were hospitalized for peritonsillar
abscess between 2000 and 2012 were identified. Table 1 shows the
baseline and clinical characteristics of the study population. The mean
Table 1
Patient's baseline and clinical characteristics (N = 12,965).
Variable Number Percentage (%)

was assigned as the index date. Gender

Boy 7329 56.5
2.2. Incidence of inpatient peritonsillar abscess in children Girl 5636 43.5
Age, years
Toddler (0–2.9) 3409 26.3
Events of inpatient peritonsillar abscess in the children were stra-
Preschool (3–5.9) 4147 32.0
tified by the index year of admission. Data on the general population School (6–11.9) 3228 24.9
size during the study period were obtained from the websites of the Adolescence (12–18) 2181 16.8
Department of Statistics of the Ministry of Interior [24]. Incidence rates Hospital level
of inpatient peritonsillar abscesses were calculated using the afore- Medical center 706 5.4
Region hospital 6347 49.0
mentioned data and the NHI coverage rate. Incidence rates were ex- District hospital 5912 45.6
pressed as the number of events per 100,000 population for a given Treatment type
year. Trends in the incidence rates and distributions of age, gender, Antibiotics only 4343 33.5
hospital faculty, medication, treatment strategy, and hospitalization Needle aspiration 8350 64.4
I&D 228 1.8
between 2000 and 2012 were also analyzed.
Tonsillectomy 44 0.3
Blood transfusion 8 0.1
2.3. Age, gender, hospital level, medication, treatment strategy, and CT 415 3.2
hospitalization ICU 40 0.3
Comorbidity 155 1.2
Medication
Data on the patients' baseline and clinical characteristics, including Analgesic drugs
age, gender, medical morbidities, and place of care (hospital level) were Paracetamol/Acetaminophen 7842 60.5
retrieved from the claims data. Age was calculated as the difference NSAIDs 9984 77.0
between the first date of admission and the children's date of birth, and Opioid 1502 11.6
Antibiotics
the children were divided into four age groups [25]. Children with
Penicillin 5107 39.4
catastrophic illness cards before the admission date were defined as Cephalosporin 8662 66.8
those with medical morbidities. Data on medications administered Macrolides 1486 11.5
during index hospitalization, including analgesics, antibiotics, and Aminoglycoside 3279 25.3
steroid medications, were extracted. Treatment strategies of peri- Metronidazole 44 0.3
Steroid 1208 9.3
tonsillar abscess were classified into four categories, namely antibiotic Hemostatic drugs 251 1.9
only; needle aspiration; incision and drainage; and tonsillectomy. The
children who had received blood transfusion, undergone computed Note: CT = computed tomography; I & D = incision and drainage;
tomography (CT) examination, or been admitted to an intensive care ICU = intensive care unit; NSAIDs = nonsteroidal anti-inflammatory drugs.

33
C.-H. Lee, et al. International Journal of Pediatric Otorhinolaryngology 125 (2019) 32–37

age was 6.6 years (standard deviation [SD] = 4.8 years), and boys
comprised 56.5% of the study population. In total, 26.3% of the pa-
tients were toddlers (1–3 years), 32.0% were of preschool age (3–5
years), 24.9% were of school age (6–12 years), and 16.8% were ado-
lescents (13–18 years). Most of these children were admitted to regional
(49.0%) or distinct hospitals (45.6%). Among the 12,965 patients, 4343
(33.5%) were treated using intravenous antibiotics only, 8350 (64.4%)
were treated using needle aspiration, 228 (1.8%) were treated using
incision and drainage, and 44 (0.3%) were treated through tonsil-
lectomy. The rate of admission to the ICU was 0.3%, and 0.1% of the
patients received blood transfusions. CT imaging was used in 415
(3.2%) of the patients.
For pain control, the most commonly administered analgesic for
pediatric peritonsillar abscess were nonsteroidal anti-inflammatory
drugs (NSAIDs, 77.0%). Acetaminophen and opioids were administered
to 60.5% and 11.6% of the patients, respectively. The most common
choice of antibiotics was cephalosporin (66.8%), followed by penicillin
(39.4%) and aminoglycoside (25.3%). Steroids were administered to
9.3% of the patients.
3.2. Incidence and trends in pediatric peritonsillar abscess in Taiwan
2000–2012
Data regarding the incidence of peritonsillar abscess in the children
are listed in Table 2. The overall incidence rate was 17.95 events per
100,000 children. The incidence rate decreased from 19.10 events in
2000 to 8.28 events in 2012 during the study period (ptrend < 0.001).
3.3. Age, gender, and hospital level
Distribution trends in age, gender, and hospital level are shown in
Table 2. The proportion of the children who were hospitalized at
medical centers increased from 4.6% in 2000 to 15.0% in 2012
(ptrend < 0.001). The mean age of the children increased from 6.5 years
(SD = 4.7 years) in 2000 to 8.3 years (SD = 5.7 years) in 2012
(ptrend < 0.001).
3.4. CT imaging and treatment strategy
During the study period, the proportion of children who received CT
imaging increased from 1.4% in 2000 to 12.0% in 2012
(ptrend < 0.001) (Table 2). An increasing trend was observed in the
proportion of children who received needle aspiration (from 49.4% in
2000 to 65.6% in 2012) and those who received incision and drainage
procedures (from 1.3% in 2000 to 4.1% in 2012) (ptrend < 0.001). A
decreasing trend was observed in the proportion of children who re-
ceived intravenous antibiotics alone (from 48.9% in 2000 to 29.0% in
2012; ptrend < 0.001) (Table 2 and Fig. 1).
3.5. Antibiotics, analgesics, and steroids
Medications, including antibiotic, analgesics, and steroids, are listed
in Table 3 and Fig. 2. The rates of cephalosporin use decreased from
65.1% in 2000 to 42.2% in 2012, while the rates of penicillin use in-
creased from 45.4% in 2000 to 67.2% in 2012. The use of NSAIDs for
pain control increased from 77.7% in 2000 to 85.5% in 2012. Opioid
usage rates during the study period decreased from 9.4% in 2000 to
8.7% in 2012. The rates of intravenous steroid use increased
throughout the study period, ranging from 6.6% in 2000 to 13.7% in
2012.
3.6. Critical care and hospitalization
The proportion of patients treated at ICUs did not change sig-
nificantly and was less than 1% during the study period (ptrend = 0.308)
(Table 2). However, the mean length of hospital stay significantly in-
creased from 3.78 days in 2000 to 4.67 days in 2012 (ptrend < 0.001)
(Table 2).
4. Discussion
This study, for the first time, analyzed the population-based data for
trends in peritonsillar abscess treatment in Asian children. The major
advantage of this study is its nationwide, population-based design,
which includes collecting comprehensive data of the study population
in Taiwan during 2000–2012. During the study period, the proportion
of CT use, the use of surgical procedures, the use of steroids, and length
of hospital stays all increased. All these findings provide crucial in-
formation to clinical physicians and facilitate the diagnosis and treat-
ment of peritonsillar abscess in the pediatric population.
In the United States, Novis et al. analyzed the Kids' Inpatient
Database and found no significant change in the incidence of peri-
tonsillar abscess among children in the United States between 2000 and
2009 (0.82–0.94 cases per 10,000, p = 0.12) [3]. By contrast, the in-
cidence of inpatient peritonsillar abscess in children decreased in
Taiwan during the study period (2000–2012). Peritonsillar abscess has
traditionally been regarded as the continuum of a condition that begins
as acute exudative tonsillitis, then progresses to cellulitis, and,

Table 2
Incidence, demographics, medical treatment, examination and intensive care across 2000–2012.
a
Year Incidence Medical center (%) Demographics Medical treatment CT Intensive care

Age (Year) Male (%) Tonsill-ectomy I&D Needle aspiration Antibiotics only ICU Admission days

2000 19.10 4.6 6.5 ± 4.7 707 (59.5) 4 (0.3) 16 (1.3) 587 (49.4) 582 (48.9) 17 (1.4) 3 (0.3) 3.78 ± 1.69
2001 14.99 6.4 7.2 ± 5.3 541 (59.1) 5 (0.5) 26 (2.8) 411 (44.9) 473 (51.7) 21 (2.3) 2 (0.2) 3.88 ± 1.73
2002 30.18 3.2 6.0 ± 4.5 1023 (56.8) 2 (0.1) 25 (1.4) 994 (55.2) 781 (43.3) 25 (1.4) 4 (0.2) 3.98 ± 1.86
2003 19.31 4.6 6.9 ± 4.8 644 (57.1) 6 (0.5) 18 (1.6) 540 (47.9) 563 (50.0) 21 (1.9) 8 (0.7) 3.99 ± 2.49
2004 13.53 6.2 7.1 ± 5.1 441 (57.1) 2 (0.3) 26 (3.4) 410 (53.1) 334 (43.3) 25 (3.2) 2 (0.3) 4.19 ± 1.87
2005 26.69 3.8 6.1 ± 4.2 805 (53.9) 4 (0.3) 26 (1.7) 1018 (68.1) 446 (29.9) 30 (2.0) 0 (0.0) 4.90 ± 2.66
2006 17.28 6.2 6.9 ± 5.0 550 (57.9) 5 (0.5) 16 (1.7) 681 (71.7) 248 (26.1) 27 (2.8) 2 (0.2) 4.98 ± 2.44
2007 22.07 3.4 6.1 ± 4.4 673 (56.7) 2 (0.2) 8 (0.7) 990 (83.4) 187 (15.8) 28 (2.4) 3 (0.3) 4.74 ± 2.34
2008 21.17 4.8 6.0 ± 4.6 599 (53.8) 2 (0.2) 14 (1.3) 968 (87.0) 129 (11.6) 36 (3.2) 4 (0.4) 5.04 ± 2.19
2009 10.70 9.3 7.0 ± 5.0 308 (56.1) 3 (0.5) 9 (1.6) 423 (77.0) 114 (20.8) 37 (6.7) 3 (0.5) 4.84 ± 2.55
2010 11.77 8.5 7.5 ± 5.4 321 (54.7) 0 (0.0) 7 (1.2) 429 (73.1) 151 (25.7) 49 (8.3) 5 (0.9) 4.83 ± 2.45
2011 18.27 7.4 7.1 ± 4.8 487 (54.9) 4 (0.5) 21 (2.4) 641 (72.3) 221 (24.9) 52 (5.9) 4 (0.5) 4.86 ± 3.13
2012 8.28 15.0 8.3 ± 5.7 230 (58.5) 5 (1.3) 16 (4.1) 258 (65.6) 114 (29.0) 47 (12.0) 0 (0.0) 4.67 ± 2.30
Total 17.95 5.4 6.6 ± 4.8 7329 (56.5) 44 (0.3) 228 (1.8) 8350 (64.4) 4343 (33.5) 415 (3.2) 40 (0.3) 4.46 ± 2.34
P trend < 0.001 < 0.001 < 0.001 0.017 < 0.001 < 0.001 0.308 < 0.001

Note.
a
Incidence numbers per 100,000 person-year. CT = computed tomography; I & D = incision and drainage; ICU = intensive care unit.

34
C.-H. Lee, et al. International Journal of Pediatric Otorhinolaryngology 125 (2019) 32–37

Fig. 1. Trends in the management of peritonsillar abscess in children.

Table 3
Drug administrations during the admission across 2000–2012.
Year NSAIDs Opioid Penicillin Cephalosporin Macrolides Aminoglycoside Steroid

2000 924 (77.7) 112 (9.4) 540 (45.4) 774 (65.1) 215 (18.1) 386 (32.5) 79 (6.6)
2001 682 (74.5) 153 (16.7) 412 (45.0) 543 (59.3) 117 (12.8) 313 (34.2) 68 (7.4)
2002 1333 (74.0) 511 (28.4) 534 (29.6) 1265 (70.2) 186 (10.3) 350 (19.4) 137 (7.6)
2003 866 (76.8) 235 (20.9) 413 (36.6) 770 (68.3) 139 (12.3) 166 (14.7) 83 (7.4)
2004 538 (69.7) 159 (20.6) 283 (36.7) 510 (66.1) 65 (8.4) 188 (24.4) 80 (10.4)
2005 1008 (67.5) 64 (4.3) 504 (33.7) 1152 (77.1) 134 (9.0) 587 (39.3) 201 (13.5)
2006 726 (76.4) 61 (6.4) 305 (32.1) 718 (75.6) 125 (13.2) 318 (33.5) 113 (11.9)
2007 950 (80.0) 38 (3.2) 271 (22.8) 914 (77.0) 143 (12.0) 300 (25.3) 105 (8.8)
2008 892 (80.1) 39 (3.5) 397 (35.7) 791 (71.1) 142 (12.8) 252 (22.6) 87 (7.8)
2009 462 (84.2) 32 (5.8) 337 (61.4) 286 (52.1) 47 (8.6) 105 (19.1) 44 (8.0)
2010 490 (83.5) 20 (3.4) 322 (54.9) 317 (54.0) 56 (9.5) 96 (16.4) 68 (11.6)
2011 777 (87.6) 44 (5.0) 525 (59.2) 456 (51.4) 85 (9.6) 155 (17.5) 89 (10.0)
2012 336 (85.5) 34 (8.7) 264 (67.2) 166 (42.2) 32 (8.1) 63 (16.0) 54 (13.7)
Total 9984 (77.0) 1502 (11.6) 5107 (39.4) 8662 (66.8) 1486 (11.5) 3279 (25.3) 1208 (9.3)
P trend < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001

Note: NSAIDs = nonsteroidal anti-inflammatory drugs; Data were presented as frequency and percentage.

Fig. 2. Trends of drug administrations in children with peritonsillar abscess.

eventually, an abscess forms [1,2]. Taiwan's NHI has a high coverage
rate (99%) and health care is easily accessible for Taiwan residents
[16–18]. Physicians in Taiwan can diagnose and manage diseases
promptly. In children with early symptoms and mild disease severity,
these patients can be treated in outpatient clinics rather than in hos-
pitals. The early detection of these patients along with the advancement
of medicine allows Taiwanese physicians to treat these patients in
outpatient clinics rather than in hospitals, thereby decreasing the rate
of hospitalization in Taiwan.
In contrast, in patients with severe disease condition, these patients
still required hospitalization. For patients with peritonsillar abscess
who required hospitalization, the use of CT enhances diagnostic accu-
racy, classifies disease severity [26–30], and facilitates clinical physi-
cians in deciding whether a surgical procedure is required [28–30]. CT
is particularly useful in an emergency department where otolar-
yngology consultation is not always available and as well as for ex-
amining patients who are young and those with complicated conditions
[28–30]. In Taiwan, the use of CT in pediatric patients with peri-
tonsillar abscess significantly increased during the study period (from
1.4% in 2000 to 12.0% in 2012). The increased use of CT scan in

35
C.-H. Lee, et al.
Taiwan allows physicians to identify the extent of the disease and
management the disease properly. Also, the health insurance in Taiwan
covers the expenditure of the CT scan. Therefore, the use of CT in in-
patient pediatric peritonsillar abscess is increased in Taiwan.
Peritonsillar abscess is an infection presenting as a collection of pus
in the peritonsillar area [1,2]. Needle aspiration and incision and
drainage are the two main treatment modalities currently used to treat
this condition [31]. Several studies have compared the effectiveness
and risk of the aforementioned treatment modalities. A Cochrane re-
view in 2016 by Chang et al. found that low-quality evidence suggested
that incision and drainage may be associated with a lower chance of
recurrence and needle aspiration is less painful [31]. However, high-
quality evidence to draw a reliable conclusion is currently unavailable
and uncertainty remains regarding which modality is superior
[12–15,31]. Currently, treatments of peritonsillar abscess in children is
toward surgical managements (i.e., drainage or needle aspiration)
[4,5]. In Taiwan, our results showed that the rate of needle aspiration
and incision and drainage procedure increased gradually. Similarly,
Qureshi et al. found an increase in the use of incision and drainage
procedures from 2000 to 2009 in the United States [11]. These findings
are consistent and indicate the growing role of pediatric otolaryngolo-
gists in the surgical management of peritonsillar abscess in pediatric
patients.
From a microbiological viewpoint, peritonsillar abscess is common
caused by Streptococcus species [32]. In Taiwan, a hospital-based study
by Hsiao et al. demonstrated that the predominant microorganisms
identified in children with peritonsillar abscess were Streptococcus
species, and the most common empirical antibiotics were penicillin-
containing regimens [33]. Their finding is consistent with that in our
study in which the rates of penicillin use increased and became the most
common regimens since 2009. Furthermore, the use of steroids also
increased in Taiwan from 2000 to 2012. Globally, steroid use is con-
sidered an adjunct therapy for patients with peritonsillar abscess
[34,35]. A meta-analysis by Lee et al. [34] and a systematic review by
Hur et al. [35] have concluded that the administration of steroids re-
duced pain-related symptoms, resulted in relatively rapid recovery, and
had no apparent adverse side effects. An increase in the use of steroids
in Taiwan may alleviate pain caused by the infection and improve the
clinical course of peritonsillar abscess in children.
To our best knowledge, there is no data comparing incidence of
peritonsillar abscess in Taiwanese children and adults. A previous study
by Klug et al. observed that the incidence rate of peritonsillar abscess
increased from childhood to peak in teenage life and declined afterward
gradually until old age [32]. This study included all inpatient peri-
tonsillar abscess in children during the study period. Our results are of
clinical implications and facilitate managements of this common dis-
ease in children.
This study has some limitations. First, the NHIRD contains dei-
dentified medical claims data. We were unable to obtain detailed chart
reviews related to clinical symptoms, physical examinations, and CT
findings to verify the diagnosis of the disease [19–23]. Second, the
NHIRD does not provide the information on laboratory findings and
culture results. Therefore, this study was unable to analyze trends in
bacteriology in peritonsillar abscess to compare them to trends in an-
tibiotic use [36–38]. Third, details of surgical procedures were not re-
corded in the NHIRD; therefore, they could not be analyzed [39].
Fourth, this study is a retrospective database search, and the study
population was identified through registered ICD-9 codes (i.e. diagnosis
code 475 peritonsillar abscess). Possibility is raised that some of the
patients had peritonsillitis, not abscess. This point should be considered
as one of the limitations of this study.
5. Conclusion
This population-based study demonstrated the incidence and trends
associated with inpatient peritonsillar abscess in children in Taiwan.
36
International Journal of Pediatric Otorhinolaryngology 125 (2019) 32–37
The incidence of peritonsillar abscess in children decreased during
2000–2012 in Taiwan. However, the use of CT, the rate of incision and
drainage as well as needle aspiration procedures, and days of hospita-
lization all increased in this cohort during the study period.
Conflicts of interest
The authors declare no conflicts of interest.
Acknowledgements
This study is based in part on data from the National Health
Insurance Research Database provided by the National Health
Insurance Administration, Ministry of Health and Welfare and managed
by National Health Research Institutes. The interpretation and conclu-
sions contained herein do not represent those of National Health
Insurance Administration, Ministry of Health and Welfare or National
Health Research Institutes. This study was supported by grant from
Taipei Hospital, Ministry of Health and Welfare (201803). The funders
had no role in study design, data collection and analysis, decision to
publish, or preparation of the manuscript. No additional external
funding was received for this study. The authors would like to thank
two anonymous reviewers and the editors for their comments.
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