Does a simple educational exercise influence practice in acute tonsillitis in children?

Abstract

Aim: To assess the concordance of treatment of children attending with tonsillitis in Paediatric Accident and Emergency with established guidelines, and subsequent review of the management of this condition after a simple educational exercise. Methods: An audit on children with tonsillitis was carried out amongst doctors working in the Paediatric Accident and Emergency Department during a three month period in 2009. Eleven doctors completed an anonymous questionnaire requesting details on presentation, symptoms, investigations and treatment of children presenting with acute tonsillitis. The results obtained from this questionnaire were compared to NICE guidelines and modified Centor (McIsaac) criteria, and fed back to the participating doctors together with copies of these guidelines via a simple, structured educational exercise. Three months later, a second identical questionnaire was again completed by the same cohort of doctors. Results: The first questionnaire showed that there was a tendency towards unnecessary prescription of antibiotics and investigations in children with acute tonsillitis, when compared to recommendations in the guidelines. Following educational feedback, the second questionnaire showed a reduction in antibiotic prescriptions by 9% (p=0.5) and investigations by 37% (p=0.1). Compliance with guidelines had improved significantly with regard to non-prescribing of antibiotics with a fever of <38oC (Phi -0.76, p=0.0005), and with tonsillar pus but no fever (Phi -0.68, p=0.002). Increased compliance was observed when prescribing antibiotics in the presence of pus plus a fever, lymphadenopathy >1cm and presence of underlying disease although these changes were not statistically significant. Conclusion: Although doctors were initially only partly compliant with established guidelines for children with acute tonsillitis, compliance improved significantly after a simple educational exercise.