Pathology
Are Emergency Medicine Physicians Able to Determine the Need for Computed Tomography and Specialist Consultation in Odontogenic Maxillofacial Infections?

https://doi.org/10.1016/j.joms.2018.07.015Get rights and content

Purpose

Pain and swelling from a necrotic tooth is a common complaint in emergency departments. These patients impose substantial burdens on hospital budgets and provider time. The initial triage of odontogenic infections can be difficult without advanced knowledge and training in head and neck anatomy and odontogenic disease pathogenesis. The purpose of this study was to determine the frequency with which emergency medicine physicians correctly determine the need for computed tomography (CT) and specialist consultation in patients with odontogenic infections.

Materials and Methods

A retrospective case series was designed. Patients older than 18 years with an odontogenic infection presenting to the emergency department from August 1, 2012 to April 30, 2015 were eligible for inclusion in the study. Demographic, clinical, laboratory, and treatment data were recorded, with special attention paid to the hospital service consulted and imaging ordered. The location of the abscess and the clinical presentation of the patient were used to determine the necessity for the imaging and consultation. Descriptive statistics were used to analyze the data.

Results

Seventy-two patients met the inclusion criteria (52.9% women; mean age, 40.0 yr). The decision to order CT was made by emergency medicine physicians for 61.7% of patients with infections that did not require CT. Likewise, oral and maxillofacial surgery was consulted for 77.8% of patients with infections that did not require a specialist consultation.

Conclusion

In this study, emergency medicine physicians misinterpreted the clinical needs of a large percentage of patients with odontogenic infections. Better education, interdepartmental collaboration, and conducting and disseminating peer-reviewed research are several ways to increase efficiency of care in patients with odontogenic infections.

Section snippets

Materials and Methods

After obtaining institutional review board approval (number 8991), the authors conducted a chart review. Patients were found through the billing department using International Classification of Diseases, Ninth Revision (ICD-9) codes at the University Medical Center in New Orleans, Louisiana, a large urban teaching hospital, from August 1, 2012 t April 30, 2015. The ICD-9 codes used were 528.3, 528.9, 682.0, and 682.1. Based on experience using these diagnosis codes, 1 in 5 to 1 in 10 charts

Results

There were 1,043 patients found in the initial search and 350 were randomly selected for review according to a computer-generated code. Of these 350 patients, 72 patients met the inclusion criteria and were included in the analysis. Patients were excluded for nonodontogenic etiology (73.4%), incomplete records (13.7%), recent trauma to the area of chief complaint (9.3%), recent surgery in the area of chief complaint (3.2%), and age younger than 18 years (0.4%). Table 1 presents demographics and

Discussion

The purpose of this study was to determine whether EM physicians can accurately determine the need for CT and specialist consultation in the management of odontogenic infections causing facial swelling. The hypothesis was that the discrepancy between triage management of odontogenic infections by EM physicians and the necessary workup determined by the specialist provider would be clinically relevant. The specific aim of the study was to assess CT use and specialist consultation by EM

References (7)

There are more references available in the full text version of this article.

Cited by (5)

  • Update on Antimicrobial Therapy in Management of Acute Odontogenic Infection in Oral and Maxillofacial Surgery

    2022, Oral and Maxillofacial Surgery Clinics of North America
    Citation Excerpt :

    Christensen and colleagues20 performed a study that determined emergency medicine physicians conducted CT imaging on 61.7% of patients who did not require CT imaging by study standards. Recommendations were made to increase education to providers to avoid unnecessary imaging.20 There is a wide array of clinical imaging that can be used to assess head and neck infections in the emergency setting, but the most common is CT imaging with IV contrast in a hospital setting and cone beam CT or panoramic film if the patient is being evaluated in an outpatient clinic.

  • When to Order Computed Tomography for Odontogenic Infections

    2019, Journal of Oral and Maxillofacial Surgery

  • Evidence-Based Clinical Criteria for Computed Tomography Imaging in Odontogenic Infections

    2019, Journal of Oral and Maxillofacial Surgery
    Citation Excerpt :

    This study is the first to examine the relation of clinical predictor variables to a diagnostic outcome variable in a prospective fashion in an attempt to define clinical guidelines for odontogenic infections. The need for these clinical criteria was made clear by a recent retrospective study that noted that EM physicians could not accurately judge the need for CT imaging and specialist consultation.6 However, it is far from the first to use CART analyses to define clinical guidelines.

  • Correlation between p16 and Interleukin-2 Gene Expression and Oral and Maxillofacial Wound Healing

    2021, Indian Journal of Pharmaceutical Sciences

  • Prevalence of odontogenic pain in a public dental urgency service in Southern Brazil

    2020, Dental Press Endodontics

Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

View full text
© 2018 American Association of Oral and Maxillofacial Surgeons