Abstract
Background
Neither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based are known.
Aim
Determine the incidence of indications for tonsillectomy in UK children and the proportion of tonsillectomies meeting evidence-based criteria.
Design & Setting
A retrospective cohort study of electronic medical records of children aged 0-15 years registered with 739 UK general practices contributing to a research database.
Method
Children with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy were then identified. Among children who had undergone tonsillectomy the numbers with evidence-based and non-evidence-based indications for surgery were determined.
Results
We included 1,630,807 children, followed up for 7,200,159 person years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years: 13.6% (2,144/15,760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years: 11.7% (2,144/18,281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: 5 to 6 sore throats (12.4%) or 2 to 4 sore throats (44.6%) in one year; sleep disordered breathing (12.3%) or obstructive sleep apnoea (3.9%).
Conclusion
In the UK, few children with evidence-based indications undergo tonsillectomy and 32,500 children annually undergo tonsillectomies from which they are unlikely to benefit.
Original language | English |
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Pages (from-to) | e33-e41 |
Journal | British Journal of General Practice |
Volume | 69 |
Issue number | 678 |
DOIs | |
Publication status | Published - Jan 2019 |
Bibliographical note
© British Journal of General Practice 2019.Keywords
- Children
- Evidence-based medicine
- Primary care
- Tonsillectomy
ASJC Scopus subject areas
- Family Practice