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Rise in children admitted to hospital with throat infections

Problems at the interface of primary and secondary care blamed

Ingrid Torjesen

Monday, 22 October 2012

The number of children admitted to hospital in England for acute throat infections increased by more than three quarters between 1999 and 2010, researchers have found.

Acute throat infection (ATI), which includes acute tonsillitis and acute pharyngitis, is one of the most common reasons for consulting a GP. The majority of ATIs are self-limiting and can be managed at home or by the GP, but a small proportion may require hospital admission.

Researchers from Imperial College London looked at admission rates for children up to age 17 with acute throat infection (ATI), including acute tonsillitis and acute pharyngitis, alongside trends in tonsillectomy rates, between 1999 and 2010. They also investigated whether performing fewer tonsillectomies is associated with higher rates of complications such as quinsy, an abscess that can occur when an infection spreads from a tonsil to the surrounding area.

The findings published in the Archives of Disease in Childhood showed that the number of children admitted to hospital with ATI increased from 12,283 in 1999 to 22,071 in 2010 – a rise of 76 per cent. Short hospital stays, lasting less than two days, increased by 115 per cent and accounted for the majority of admissions. Stays of two or more days in hospital for ATI decreased slightly, while quinsy rates remained stable. There was no association between tonsillectomy trends and admission rates or the severity of ATI or quinsy.

The researchers suggested that one possible reason for the dramatic increase in ATI admissions was that a large number of children being admitted for ATIs who would have formerly been managed in the community. This may have been partly because the four hour maximum waiting time in Accident and Emergency, introduced in 2002, might have meant that doctors were under greater pressures and therefore more inclined to admit children to hospital with an ATI.

Dr Elizabeth Koshy, from the School of Public Health at Imperial College London, said: “It is very concerning that there has been a major increase in hospital admissions for children with acute throat infections, particularly among those aged under five. We think this is likely to be due to problems at the primary care and secondary care interface.

“Our findings relating to short hospital stays suggest that many of the children admitted with acute throat infections could have been effectively managed in the community. Our study highlights the need to urgently address the issue of healthcare access, with improved models of integrated care within primary and secondary care, to avoid potentially unnecessary hospital admissions for relatively minor infections in the future.”

Although these findings suggest that declining tonsillectomy rates do not appear to be associated with an increase in more severe ATI or quinsy rates, further research is needed to confirm this, Dr Koshy said.  “Tonsillectomy is a major and costly operation with potentially serious complications. So it seems sensible for clinicians to maintain a high threshold for referring children with recurrent throat infections for tonsillectomy and restrict it to those children who are most severely affected by these infections.”

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