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Aspiración con aguja versus incisión y drenaje para el tratamiento del absceso periamigdalino

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Referencias

Referencias de los estudios incluidos en esta revisión

Chi 2014 {published data only}

Chi TH, Yuan CH, Tsao YH. Comparison of needle aspiration with incision and drainage for the treatment of peritonsillar abscess. WIMJ Open 2014;1(1):11‐3. CENTRAL

Khan 2011 {published data only}

Khan Q, Hamza A, Haleem G, Wahid FI. Comparative study of management of peritonsillar abscess by needle aspiration versus incision and drainage. Pakistan Journal of Medical & Health Sciences 2011;5(4):699‐701. CENTRAL

Khan 2012 {published data only}

Khan MI, Iqbal K, Muhammad. Peritonsillar abscess: comparison of outcome of incision and drainage versus needle aspiration. Gomal Journal of Medical Sciences 2012;10(2):205‐8. CENTRAL

Khokhar 2015 {published data only}

Khokhar MR, Raza SN, Ayaz SB. Comparison of efficacy of needle aspiration versus incision and drainage in management of peritonsillar abscess. Pakistan Armed Forces Medical Journal 2015;65:172‐7. CENTRAL

Maharaj 1991 {published data only}

Maharaj D, Rajah V, Hemsley S. Management of peritonsillar abscess. Journal of Laryngology and Otology 1991;105:743‐5. CENTRAL

Nwe 2000 {published data only}

Nwe TT, Singh B. Management of pain in peritonsillar abscess. Journal of Laryngology and Otology 2000;114:765‐7. CENTRAL

Rafi 2007 {published data only}

Rafi T, Farooq MU, Sheikh HU. Comparative study of management of peritonsillar abscess by needle aspiration versus incision and drainage. Journal of Surgery Pakistan 2007;12(3):126‐8. CENTRAL

Sheikh 2012 {published data only}

Sheikh ZA, Najam A, Ahmed A. Needle aspiration an equal to incision and drainage in management of peritonsillar abscess. Pakistan Armed Forces Medical Journal 2012;62(2):online. CENTRAL

Spires 1987 {published data only}

Spires JR, Owens JJ, Woodson GE, Miller RH. Treatment of peritonsillar abscess. Archives of Otolaryngology ‐ Head & Neck Surgery 1987;113:984‐6. CENTRAL

Stringer 1988 {published data only}

Stringer SP, Schaefer SD, Close LG. A randomized trial for outpatient management of peritonsillar abscess. Archives of Otolaryngology ‐ Head & Neck Surgery 1988;114(3):296‐8. CENTRAL

Younas 2015 {published data only}

Younas M. Satisfaction of patients with peritonsillar abscess with permucosal needle aspiration versus incision & drainage. Medical Forum Monthly 2015;26(3):37‐9. CENTRAL

Referencias de los estudios excluidos de esta revisión

Fry 1987 {published data only}

Fry TL. A randomized trial for outpatient management of peritonsillar abscess. Archives of Otolaryngology ‐‐ Head and Neck Surgery 1987;113(1):19. CENTRAL

Herzon 1995 {published data only}

Herzon FS. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope 1995;105:1‐17. CENTRAL

Khayr 2005 {published data only}

Khayr W, Taepke J. Management of peritonsillar abscess: needle aspiration versus incision and drainage versus tonsillectomy. American Journal of Therapeutics 2005;12:344‐50. CENTRAL

Kulkarni 2013 {published data only}

Kulkarni V, Patel T. Management of peritonsillar abscess: comparative prospective study of needle aspiration and incision & drainage in central Indian population. Asian Journal of Biomedical and Pharmaceutical Sciences 2013;3(18):61‐3. CENTRAL

Stringer 1986 {published data only}

Stringer SP, Schaefer SD, Close LG. A randomized trial for outpatient management of peritonsillar abscess. Otolaryngology ‐ Head and Neck Surgery 1986;114(3):296‐8. CENTRAL

Wolf 1994 {published data only}

Wolf M, Even‐Chen I, Kronenberg J. Peritonsillar abscess: repeated needle aspiration versus incision and drainage. Annals of Otology, Rhinology & Laryngology 1994;103(7):554‐7. CENTRAL

Referencias de los estudios en espera de evaluación

Tyagi 2011 {published data only}

Tyagi V, Kaushal A, Garg D, De S, Nagpure P. Treatment of peritonsillar abscess: a prospective study of aspiration versus incision and drainage. Calcutta Medical Journal 2011;9(3):e3. CENTRAL

Hall 1990

Hall SF. Peritonsillar abscess: the treatment options. Journal of Otolaryngology 1990;19:226‐9.

Handbook 2011

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Johnson 2003

Johnson RF, Stewart MG, Wright CC. An evidence based review of the treatment of peritonsillar abscess. Otolaryngology ‐ Head and Neck Surgery 2003;128(3):332‐43.

Johnson 2005

Johnson RF, Stewart MG. The contemporary approach to diagnosis and management of peritonsillar abscess. Current Opinion in Otolaryngology & Head and Neck Surgery 2005;13:157‐60.

Mehanna 2002

Mehanna HM, Al‐Bahnasawi L, White A. National audit of the management of peritonsillar abscess. Postgraduate Medical Journal 2002;78(923):545‐8.

Ong 2004

Ong YK, Goh YH, Lee YL. Peritonsillar infections: local experience. Singapore Medical Journal 2004;45(3):105‐9.

Powell 2012

Powell J, Wilson JA. An evidence‐based review of peritonsillar abscess. Clinical Otolaryngology 2012;37(2):136‐45. [PUBMED: 22321140]

Qureshi 2015

Qureshi H, Ference E, Novis S, Pritchett CV, Smith SS, Schroeder JW. Trends in the management of pediatric peritonsillar abscess infections in the U.S., 2000‐2009. International Journal of Pediatric Otorhinolaryngology 2015;79(4):527‐31.

RevMan 2014 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Referencias de otras versiones publicadas de esta revisión

Chang 2014

Chang BA, Thamboo A, Diamond C, Nunez DA. Needle aspiration versus incision and drainage for the treatment of peritonsillar abscess. Cochrane Database of Systematic Reviews 2014, Issue 7. [DOI: 10.1002/14651858.CD006287.pub3]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Chi 2014

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 110

Age range: 12 to 79

Gender: 89% males

Setting: hospital, Taiwan

Inclusion criteria: diagnosis of peritonsillar abscess

Exclusion criteria: none stated

Participant characteristics: mean age = 31.0 ± 15.0 years, days of symptoms prior to presentation = 4.7 ± 2.8

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 55

Comparator group: incision and drainage

n = 55

Use of additional interventions: antibiotics, intravenous hydration

Outcomes

1. Recurrence rate

2. Length of hospital stay

3. Pain score

(Outcomes not specified as primary/secondary)

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Participants lost to follow‐up: none

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "Patients were randomly divided into two groups..."

Comment: specific method of randomisation not stated

Allocation concealment (selection bias)

Unclear risk

Allocation concealment not specified

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All patients presumably accounted for (admitted as inpatients); no dropouts stated

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias. Incomplete methodological description (definition of recurrence/criteria for re‐intervention not described, timing of assessment for recurrence not described).

Khan 2011

Methods

Allocation: randomised trial, alternation

Design: parallel‐group

Participants

Number randomised: 62

Age range: 15 to 35

Gender: 74% males

Setting: hospital, Pakistan

Inclusion criteria: not specifically stated

Exclusion criteria: other associated illness

Participant characteristics: mean age = 24.6 years

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 31

Comparator group: incision and drainage

n = 31

Use of additional interventions: antibiotics (injection benzyl penicillin and metronidazole), analgesics

Outcomes

1. Recurrence rate

2. Length of hospital stay

(Outcomes not specified as primary/secondary)

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Needle aspiration failures treated with incision and drainage

Participants lost to follow‐up: none

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Unclear risk

No allocation concealment specified

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All patients presumably accounted for (admitted as inpatients); no dropouts stated

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias. Incomplete methodological description (definition of recurrence/criteria for re‐intervention not described, timing of assessment for recurrence not described).

Khan 2012

Methods

Allocation: randomised trial, alternation

Design: parallel‐group

Participants

Number randomised: 56

Age range: 16 to 50

Gender: 71% males

Setting: hospital, Pakistan

Eligibility criteria: age > 15 years with peritonsillar abscess

Exclusion criteria: patients with bleeding disorders, acute follicular tonsillitis

Participant characteristics: mean age = 31.2 years

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 28

Comparator group: incision and drainage

n = 28

Use of additional interventions: antibiotics (intravenous amoxicillin/clavulanate and metronidazole), povidone‐iodine (Pyodine) mouth wash, intravenous crystalloid (if necessary)

Outcomes

1. Recurrence rate

2. Symptom score

3. Length of hospital stay

(Outcomes not specified as primary/secondary)

Funding sources

None stated

Declarations of interest

None declared

Notes

Alternate basis randomisation

Participants lost to follow‐up: none

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Alternate basis randomisation

Allocation concealment (selection bias)

High risk

Alternate basis randomisation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All patients presumably accounted for (admitted as inpatients); no dropouts stated

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias. Incomplete methodological description (definition of recurrence/criteria for re‐intervention not described, timing of assessment for recurrence not described)

Khokhar 2015

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 70 (data reported on 60)

Age range: 17 to 53

Gender: 76.7% males

Setting: military hospital, Pakistan

Inclusion criteria: "clinical diagnosis of PTA was made on clinical features of unitonsillar erythema, swelling, odynophagia (pain on swallowing), uvular deviation towards the opposite direction and trismus", age ≥ 15

Exclusion criteria: "patients with a history of bleeding disorders or diabetes mellitus, on anticoagulant drugs or diagnosed with immunodeficiency disorders or who refused to undergo the procedure under local anesthesia"; "Patients failing to follow up were excluded from this study"

Participant characteristics: mean age 32.7

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 35

Comparator group: incision and drainage

n = 35

Use of additional interventions:

Use of additional interventions: antibiotics and analgesia ((a) co‐amoxiclav 1.2 g intravenously 8‐hourly and metronidazole 500 mg intravenously 8‐hourly for 3 days, followed by oral co‐amoxiclav 1 g twice daily and metronidazole 400 mg 3 times a day for the next 4 days, (b) paracetamol 1 g 8‐hourly orally "for fever and analgesia")

Outcomes

1. Time of resolution of odynophagia (days)

2. Fever – time to resolution (days)

Above information used to define "Recovery period" as "time taken to settle both odynophagia and fever"

3. Recurrence

4. Complications

Funding sources

Not specified

Declarations of interest

None declared

Notes

Participants lost to follow‐up: "Patients failing to follow up were excluded from this study"

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Used a "random numbers table"

Allocation concealment (selection bias)

Unclear risk

Not certain if random numbers table was open

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

1. "Patients, who had cultured organisms resistant to [the] antibiotics [named above] were excluded from the study"

2. "Patients failing to follow up were excluded from this study"

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias

Maharaj 1991

Methods

Allocation: randomised, alternation

Design: parallel‐group

Participants

Number randomised: 60

Age range: "under 14" to "over 40"

Gender: not specified

Setting: hospital, South Africa

Inclusion criteria: positive needle aspiration

Exclusion criteria: negative needle aspiration

Participant characteristics: mean age not provided, "all patients presented with some degree of odynophagia and drooling of saliva", 47% had trismus and 27% had pyrexia

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 30

Comparator group: incision and drainage

n = 30

Use of additional interventions: antibiotics (penicillin), analgesics, mouthwash (unspecified)

Outcomes

1. Recurrence rate

(Outcomes not specified as primary/secondary)

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Participants lost to follow‐up: 11 (18%) at day 1, 22 (37%) at day 7

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Randomised on alternate basis

Allocation concealment (selection bias)

High risk

Randomised on alternate basis

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

High risk

82% of patients followed up on day 1 post‐treatment and 63% followed up on day 7

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Low risk

No other sources of bias identified

Nwe 2000

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 75 (only 50 patients were in groups compared in this review)

Age range: 15 to 43

Gender: 33% males

Setting: South Africa

Inclusion criteria: not described

Exclusion criteria: none stated

Participant characteristics: "unilateral swelling of the tonsil and soft palate, and medial displacement of the uvula", "all patients were pyrexial"

Interventions

Needle aspiration versus incision and drainage versus intravenous antibiotics alone

Intervention group: intravenous antibiotics

n = 25

Comparator group 1: needle aspiration

n = 25

Comparator group 2: incision and drainage

n = 25

Use of additional interventions: single dose of intravenous antibiotics

Outcomes

1. Distance between upper and lower incisor teeth (degree of trismus)

2. Body temperature

3. Ability to drink water

4. Microbiology cultures

5. Treatment failures (recurrence)

Funding sources

None stated

Declarations of interest

None declared

Notes

Participants lost to follow‐up: unclear

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Unclear risk

No allocation concealment specified

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition not clear, dropouts not mentioned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias

Rafi 2007

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 50

Age range: 22 to 43

Gender: 94% males

Setting: hospital, Pakistan

Inclusion criteria: "peritonsillar abscess"

Exclusion criteria: none stated

Participant characteristics: "all the patients were otherwise healthy and young with no immune compromising disease", no patients with previous peritonsillar abscess

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 25

Comparator group: incision and drainage

n = 25

Use of additional interventions: antibiotics (lincomycin)

Outcomes

1. Recurrence rate

2. Length of hospital stay

3. "Period of recovery"

(Outcomes not specified as primary/secondary)

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Participants lost to follow‐up: none

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Unclear risk

No allocation concealment specified

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All patients presumably accounted for (admitted as inpatients); no dropouts stated

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias. Incomplete methodological description (definition of recurrence/criteria for re‐intervention not described, timing of assessment for recurrence not described)

Sheikh 2012

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 50

Age range: 18 to 51

Gender: 62% males

Setting: hospital, Pakistan

Inclusion criteria: "presented with peritonsillar abscess"

Exclusion criteria: diabetics, less than 18 years old

Participant characteristics: mean age = 32.7 years

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 25

Comparator group: incision and drainage

n = 25

Use of additional interventions: antibiotics, chlorhexidine mouth wash

Outcomes

Primary outcome: recurrence rate

Secondary outcomes: none

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Needle aspiration failures treated with incision and drainage

Participants lost to follow‐up: none

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Unclear risk

No allocation concealment specified

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Low risk

All patients presumably accounted for (admitted as inpatients); no dropouts stated

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias. Subjective definition of recurrence/criteria for re‐intervention

Spires 1987

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 62

Age range: 12 to 53

Gender: "2:1 male predilection"

Setting: hospital, USA

Inclusion criteria: not specified

Exclusion criteria: not specified

Participant characteristics: median age = 24; 1 patient with bilateral abscesses

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 41

Comparator group: incision and drainage

n = 21

Use of additional interventions: analgesics, antibiotics (penicillin V or cephalexin or erythromycin)

Outcomes

1. Recurrence rate

2. Time to resumption of normal diet

(Outcomes not specified as primary/secondary)

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Only partial randomisation

Participants lost to follow‐up: unclear

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

First 15 participants treated with needle aspiration, then patients were subsequently randomised

Allocation concealment (selection bias)

High risk

Randomised by hospital number

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding made; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition not clear, dropouts not mentioned

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risk of bias. Incomplete methodological description (definition of recurrence/criteria for re‐intervention not described)

Stringer 1988

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 52

Age range: 13 to 60

Gender: 60% males

Setting: hospital, USA

Inclusion criteria: positive needle aspiration

Exclusion criteria: negative needle aspiration

Participant characteristics: mean age = 27 years average duration of symptoms prior to presentation = 5.3 days

Interventions

Needle aspiration versus incision and drainage

Intervention group: needle aspiration

n = 24

Comparator group: incision and drainage

n = 28

Use of additional interventions: antibiotics (initial dose of intramuscular penicillin G followed by intramuscular penicillin G or oral penicillin V for 10 days), erythromycin/cephalosporin/clindamycin if allergic

Outcomes

1. Recurrence rate

2. Symptom score

(Outcomes not specified as primary/secondary)

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Authors contacted and further information/clarification obtained

Participants lost to follow‐up: unclear

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

High risk

No allocation concealment performed

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding not performed

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding made; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts mentioned

Selective reporting (reporting bias)

Low risk

All measured outcomes stated to have been reported

Other bias

Unclear risk

Not enough data to assess other risk of bias. Subjective definition of recurrence/criteria for re‐intervention.

Younas 2015

Methods

Allocation: randomised trial

Design: parallel‐group

Participants

Number randomised: 62 (discrepant total = 64 in results)

Age range: 8 to 57

Gender: 61.3% male

Setting: hospital, Pakistan

Eligibility criteria: "clinically diagnosed for peritonsillar abscess"

Exclusion criteria: none stated

Participant characteristics: average duration of symptoms prior to presentation = 6 days; 84% treated with antibiotics prior to presentation

Interventions

Intervention group: needle aspiration

n = 32

Intervention group: incision and drainage

n = 32

Use of additional interventions: not stated

Outcomes

1. "Success" – not defined

2. Length of time to return to semisolid/solid food (days)

3. Proportion with "no pain by 05 days" (%)

4. Length of hospital stay (days)

Funding sources

Not specified

Declarations of interest

Not specified

Notes

Participants lost to follow‐up: unclear

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Unclear risk

No allocation concealment specified

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of blinding; probably not done

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No mention of blinding; probably not done

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition not clear; dropouts not mentioned; numbers in methods and results do not match

Selective reporting (reporting bias)

Unclear risk

Insufficient information to permit a judgement of high or low risk

Other bias

Unclear risk

Not enough data to assess other risks of bias

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Fry 1987

Commentary

Herzon 1995

Review paper

Khayr 2005

Review paper

Kulkarni 2013

Participants were not randomised: "All patients were divided in two groups according to surgical procedures carried out". While the study states that this was a prospective study, it seems that outcomes were assessed retrospectively.

Stringer 1986

Considered a duplicate publication of Stringer 1988

Wolf 1994

Retrospective study

Characteristics of studies awaiting assessment [ordered by study ID]

Tyagi 2011

Methods

Participants

Interventions

Outcomes

Notes

Study not available at this time. This study was inaccessible by all attempted means, including contact with the journal editor

Data and analyses

Open in table viewer
Comparison 1. Needle aspiration versus incision and drainage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Rate of recurrence Show forest plot

10

612

Risk Ratio (M‐H, Random, 95% CI)

3.74 [1.63, 8.59]

Analysis 1.1

Comparison 1 Needle aspiration versus incision and drainage, Outcome 1 Rate of recurrence.

Comparison 1 Needle aspiration versus incision and drainage, Outcome 1 Rate of recurrence.

Process for sifting search results and selecting studies for inclusion.
Figuras y tablas -
Figure 1

Process for sifting search results and selecting studies for inclusion.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Needle aspiration versus incision and drainage, Outcome 1 Rate of recurrence.
Figuras y tablas -
Analysis 1.1

Comparison 1 Needle aspiration versus incision and drainage, Outcome 1 Rate of recurrence.

Summary of findings for the main comparison. Needle aspiration versus incision and drainage for the treatment of peritonsillar abscess

Needle aspiration versus incision and drainage for the treatment of peritonsillar abscess

Patient or population: patients older than 8 years with peritonsillar abscess
Setting: inpatients and outpatients
Intervention: incision and drainage
Comparison: needle aspiration

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with incision and drainage

Risk with needle aspiration

Primary outcome: recurrence rate

Study population

RR 3.74, 95% CI 1.63 to 8.59

612

(10 RCTs)

⊕⊝⊝⊝
very low1,2

47 per 1000

245 per 1000

Primary outcome: adverse effects/events associated with the interventions

One study reported post‐procedural bleeding in 1 patient (3.6%) in the incision and drainage group, with no adverse effects/events reported in the needle aspiration group. Two studies stated that no complications were seen in either group.

226

(3 RCTs)

⊕⊝⊝⊝
very low2,3

Adverse effects/events were not mentioned as a pre‐specified outcome measure in any of the studies.

Secondary outcome: time to resumption of normal diet

One study found no difference in the time to resumption of normal diet (mean 3.7 days in both groups, no confidence intervals provided). Another study found that a similar percentage of patients returned to solid food within 4 days (87%: needle aspiration, 88%: incision and drainage).

124

(2 RCTs)

⊕⊝⊝⊝
very low2,4

Secondary outcome: complications of the disease process

One study described a complication of 2 patients requiring admission to hospital for dehydration in the incision and drainage group and no complications in the needle aspiration group. One study stated that no complications were seen in either group.

170

(2 RCTs)

⊕⊝⊝⊝
very low2,5

Complications of the disease process were not mentioned as a pre‐specified outcome measure in any of the studies.

Secondary outcome: symptom scores
(Multiple different outcome scales used)

Procedural pain

Study 1

Pain was less in the needle aspiration group: MD ‐0.8, 95% CI ‐1.16 to ‐0.44 (10‐point scale)

Study 2

Reported less pain in the needle aspiration group

Pain resolution

Study 3

Pain resolution was similar between groups at 5 days post‐intervention

Other symptoms

Study 4

Reported comparable symptom scores between groups at presentation and 48 hours

Study 1

110 participants

Study 2

56 participants

Study 3

62 participants

Study 4

52

participants

⊕⊝⊝⊝
very low2,6

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1Downgraded once due to serious risk of inconsistency (unexplained heterogeneity).

2Downgraded twice due to very serious risk of bias (limitations in study design).

3Adverse event (post‐procedural bleeding) was not well described.

4Incomplete data (no standard deviations or confidence intervals provided).

5Admission to hospital for rehydration is inherently subjective and depends on multiple clinical variables.

6Downgraded once due to imprecision and differences in data reporting.

Figuras y tablas -
Summary of findings for the main comparison. Needle aspiration versus incision and drainage for the treatment of peritonsillar abscess
Table 1. Definition of recurrence and timing

Study ID

Definition of recurrence or criteria for re‐intervention described

Timing of assessment of recurrence

Spires 1987

No

2, 7 days (2x returned day 1)

Stringer 1988

"Failure to improve symptom scale score; visual evidence of a persistent abscess"

1, 2 days (24, 48 hours)

Maharaj 1991

"reaccumulation of pus"

1, 7 days

Nwe 2000

"patients in whom the trismus and pyrexia persisted 48 hours after the initial treatment"

2 days (48 hours)

Rafi 2007

No

Not stated

Khan 2011

No

Not stated

Khan 2012

No

Not stated

Sheikh 2012

Yes*

0, 1, 2 days

Chi 2014

No

Not stated

Khokhar 2015

No

"during the course of the study", 7, 14 days

Younas 2015

N/A

N/A

* "Improvement in patients was determined by examining the patient the next day after the procedure, a reduction in supra tonsillar swelling along with decrease in pain and also improvement in odynophagia were taken as criteria of improvement and termination of surgical attempts."

N/A: not available

Figuras y tablas -
Table 1. Definition of recurrence and timing
Comparison 1. Needle aspiration versus incision and drainage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Rate of recurrence Show forest plot

10

612

Risk Ratio (M‐H, Random, 95% CI)

3.74 [1.63, 8.59]

Figuras y tablas -
Comparison 1. Needle aspiration versus incision and drainage