Experts explore decline in throat infection admissions

By Piriya Mahendra, medwireNews Reporter

Hospital admissions for acute throat infection (ATI) in children have increased significantly over the past decade in the UK, while the rate of tonsillectomy has declined, researchers report.

However, Elizabeth Koshy (Imperial College London, UK) and team stress that the declining tonsillectomy rate is not associated with the increased trend in ATI admissions.

Between April 1999 and March 2010, age-standardized admission rates for ATI increased by 76% from 107.3 to 188.4 admissions per 100,000 children. The median length of stay for ATI admissions declined from 1 to 0 days.

Meanwhile, admission rates for peritonsillar abscess remained stable from 1999-2000 and 2009-2010, at between 9.6 and 8.7 cases per 100,000 children, respectively.

These findings suggest that the severity of throat infection has not increased during the past decade, say the authors in the Archives of Diseases in Childhood.

The age-standardized rates of tonsillectomy declined from 367.4 in 1999-2000 to 278.0 in 2000-2001, and then increased to 322.3 per 100,000 children in 2002-2003. The rate then declined again to 293.6 cases per 100,000 children in 2009-2010.

Koshy told medwireNews: "In terms of the ATI admission rates, there are a number of possible explanations and this study cannot definitively answer which factors have actually led to this."

She suggests that some of the underlying causes for the association between ATI admissions and tonsillectomy rate could include changes in the provision of out-of-hours care in general practice (GP) and an increase in workload in accident and emergency departments.

However, Koshy stressed: "We can suggest possibilities but certainly cannot claim that GP out-of-hours or any other individual factor is responsible."

She said: "There have been concerns that we have seen an increase in ATI admissions and that this might be the consequence of declining tonsillectomy trends. The key message from this study is that using group-level data, there doesn't seem to be that association. There doesn't seem to be as much of a concern as we have been led to believe. But we do need more studies with individual-level data to see if that's actually replicated."

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