Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Children with Suspected Pharyngitis or Peritonsillar Abscess (PTA)

  • RN standing order for rapid strep:
    • Chief complaint: sore throat
    • Age ≥ 3 yrs
    • No new viral URI symptoms
  • Features of PTA
    • Palatal fullness
    • Uvula deviation
    • Trismus
    • Unilateral throat pain, ipsilateral otalgia
Peritonsillar Cellulitis/Possible PTA
Clinical PTA
  • Rapid strep if features of strep pharyngitis
  • Rapid strep testing not recommended for:
    • Prominent viral symptoms
    • Age < 3 yrs w/o known exposure
  • Consider STI in sexually active adolescent
  • Viral Pharyngitis
    • Monospot or EBV serologies as indicated
    • Supportive care
Unable to tolerate bedside drainage
Able to tolerate bedside drainage
Consider Imaging
  • Consider Imaging
  • Consider ENT Consult based on imaging
Consult ENT for Bedside Drainage
  • Tolerating PO
  • Pain controlled
For dehydration
  • Discharge for PTA
    • Successful drainage
      (if attempted)
    • Follow up with PCP in 48 hrs
    • If second occurrence of PTA, follow up with ENT to discuss elective tonsillectomy