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Rising acute throat infection admissions in children are not related to falling tonsillectomy rates
  1. E Koshy1,
  2. J Murray1,
  3. A Bottle2,
  4. P Aylin2,
  5. M Sharland3,
  6. A Majeed1,
  7. S Saxena1
  1. 1Primary Care and Public Health, Imperial College London, London, UK
  2. 2Dr Foster Unit at Imperial College London, Imperial College London, London, UK
  3. 3Paediatric Infectious Diseases Unit, St George's Hospital, London, UK

Abstract

Aim To investigate if there is an association between hospital admission trends for acute throat infection and peritonsillar abscess (PTA) with tonsillectomy rates in children.

Methods We analysed Hospital Episodes Statistics data for children aged <18 years admitted to hospital in England with a primary diagnosis of acute tonsillitis or acute pharyngitis (‘acute throat infection’) or PTA, and tonsillectomy rates between 1st April 1999 and 31st March 2010. Annual age-standardised and age-sex specific hospital admission and tonsillectomy rates were calculated.

Results Age-standardised hospital admission rates for acute throat infection increased linearly by 76% from 107.3 (95% CI 105.3-109.2) to 188.4 (95% CI 185.9-191.0) admissions per 100,000 children. Age-standardised admission rates for PTA were stable, between 9.6 (95% CI 9.0-10.2) and 8.7 (95% CI 8.1-9.2) per 100,000 children in 1999/2000 and 2009/10, respectively.

Median length of stay (LOS) for acute throat infection admissions decreased from 1 to 0 days. Age-standardised admission rates for acute throat infection with a median LOS <2 days increased from 73 (95% CI 72-75) per 100,000 children in 1999/2000 to 157 (95% CI 155-160) in 2009/10. By contrast, the corresponding rates for a median LOS ≥2 days remained stable between 34 (95% CI 33-35) and 31 (95% CI 30-32) per 100,000 children in 1999/2000 and 2009/10, respectively. The median LOS for PTA remained at 2 days.

Age-standardised tonsillectomy rates declined by 24% from 367.4 (95% CI 363.8-371.0) to 278.0 (95% CI 274.9-281.1) per 100,000 children between 1999/2000 and 2000/1, respectively. Tonsillectomy rates then increased to 322.4 (95% CI 319.0-325.7) in 2002/3 and then gradually declined to 2009/10.

Conclusion Acute throat infection hospital admission rates markedly increased between 1999/2000 and 2009/10 and the majority of children were discharged on the same day. PTA admission rates remained stable. These findings suggest that the severity of throat infection did not increase over the study period. Tonsillectomy rates in England remain low compared with other European countries and do not explain this increasing trend in acute throat infection admissions, which is most likely to reflect changes in healthcare provision in primary care.

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