Sharp rise in children admitted to hospital with throat infections since 1999

Public release date: 19-Oct-2012
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Contact: Sam Wong
sam.wong@imperial.ac.uk
44-207-594-2198
Imperial College London

The number of children admitted to hospital in England for acute throat infections increased by 76 per cent between 1999 and 2010, according to new research published today in Archives of Disease in Childhood.

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.

This study investigated admission rates for children up to age 17 with ATI alongside trends in tonsillectomy rates, between 1999 and 2010. The study was motivated by concerns that the decline in tonsillectomy rates in recent years has led to an increase in hospital admissions for tonsillitis of increased severity. It 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 research, which was funded by a fellowship from the National Institute for Health Research, showed that the number of children admitted to hospital with ATI increased from 12,283 in 1999 to 22,071 in 2010 - a rise in admission rate of 76 per cent. Short hospital stays, lasting less than two days, increased by 115 per cent over the decade, and accounted for the majority of admissions. Stays of two or more days in hospital for ATI decreased slightly, while quinsy rates remained stable. The authors found no evidence of an association between tonsillectomy trends and admission rates or the severity of ATI or quinsy.

The authors suggest that the dramatic increase in ATI admissions is probably explained by a large number of children being admitted for ATIs who would have formerly been managed in the community. The reasons for this may include changes in the provision of out-of-hours care in general practice and an increase in workload in Accident in Emergency departments. The four hour maximum waiting time in A&E, introduced in 2002, might have meant that doctors, who are under greater pressures, are more inclined to admit children to hospital with an ATI, the authors suggest.

Dr Elizabeth Koshy, from the School of Public Health at Imperial College London, who led the study 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 adds: "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."

###

For further information please contact:

Sam Wong
Research Media Officer
Imperial College London
Email: sam.wong@imperial.ac.uk
Tel: +44(0)20 7594 2198
Out of hours duty press officer: +44(0)7803 886 248

Notes to editors

1. Reference: E Koshy et al. (2012) 'Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates?' Arch Dis Child doi:10.1136/archdischild-2012-301755

http://adc.bmj.com/content/early/2012/10/17/archdischild-2012-301755.full

2. About Imperial College London

Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.

Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve global health, tackle climate change, develop sustainable sources of energy and address security challenges.

In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.

Website: www.imperial.ac.uk

3. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 19-Oct-2012
[ | E-mail | Share ]

Contact: Sam Wong
sam.wong@imperial.ac.uk
44-207-594-2198
Imperial College London

The number of children admitted to hospital in England for acute throat infections increased by 76 per cent between 1999 and 2010, according to new research published today in Archives of Disease in Childhood.

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.

This study investigated admission rates for children up to age 17 with ATI alongside trends in tonsillectomy rates, between 1999 and 2010. The study was motivated by concerns that the decline in tonsillectomy rates in recent years has led to an increase in hospital admissions for tonsillitis of increased severity. It 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 research, which was funded by a fellowship from the National Institute for Health Research, showed that the number of children admitted to hospital with ATI increased from 12,283 in 1999 to 22,071 in 2010 - a rise in admission rate of 76 per cent. Short hospital stays, lasting less than two days, increased by 115 per cent over the decade, and accounted for the majority of admissions. Stays of two or more days in hospital for ATI decreased slightly, while quinsy rates remained stable. The authors found no evidence of an association between tonsillectomy trends and admission rates or the severity of ATI or quinsy.

The authors suggest that the dramatic increase in ATI admissions is probably explained by a large number of children being admitted for ATIs who would have formerly been managed in the community. The reasons for this may include changes in the provision of out-of-hours care in general practice and an increase in workload in Accident in Emergency departments. The four hour maximum waiting time in A&E, introduced in 2002, might have meant that doctors, who are under greater pressures, are more inclined to admit children to hospital with an ATI, the authors suggest.

Dr Elizabeth Koshy, from the School of Public Health at Imperial College London, who led the study 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 adds: "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."

###

For further information please contact:

Sam Wong
Research Media Officer
Imperial College London
Email: sam.wong@imperial.ac.uk
Tel: +44(0)20 7594 2198
Out of hours duty press officer: +44(0)7803 886 248

Notes to editors

1. Reference: E Koshy et al. (2012) 'Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates?' Arch Dis Child doi:10.1136/archdischild-2012-301755

http://adc.bmj.com/content/early/2012/10/17/archdischild-2012-301755.full

2. About Imperial College London

Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.

Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve global health, tackle climate change, develop sustainable sources of energy and address security challenges.

In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.

Website: www.imperial.ac.uk

3. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

---

[ | E-mail | Share ]

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2012-10/icl-sri101912.php

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