# Results

## Centres

Data were submitted by 83/86 UK centres who registered to take part (72 in England, 5 in Scotland, 3 in Wales and 3 in Northern Ireland). 2/83 centres submitted data covering the first period only. The dates centres opened are shown in figure 1, alongside the median rates of tonsillitis and PTA cases referred per centre per week.

## Submissions

1,181 cases met the prespecified eligibility criteria across the three periods (765 tonsillitis cases [276, 212 and 277 cases respectively] and 416 PTA cases [131, 129 and 156 cases respectively]). Characteristics of both populations are shown in tables 1 and 2. Data completeness was 99.2% (n=592/597) of cases having data for the primary outcome.

## COVID-19

Figure 1 shows the number of patients with suspected or confirmed COVID-19, at the time of presentation and following testing, for the three audit periods, alongside the UK incidence of COVID-19.

## Acute management of ED patients

An oral examination was performed in 91.0% of tonsillitis patients and 91.7% of PTA patients (n=678/745 and n=376/410). FNE was performed in 4.6% of tonsillitis patients and 9.5% of PTA patients (n=34/745 and n=39/410).
The rates of use of IV medications are shown in tables 1 and 2. IV antibiotics were given in 79.6% of tonsillitis patients (n=600/754) and 89.6% of PTA patients (n=370/413). IV steroids were given in 67.0% of tonsillitis patients (n=505/754) and 73.6% of PTA patients (n=304/413).
Suspected PTA underwent attempted drainage in 77.2% of cases (n=319/413). Needle aspiration was used in 78.6% of these cases (n=246/313) and produced pus in 54.4% (n=134/246). Incision and drainage was used in 21.4% (n=67/313) and produced pus in 82.1% (n=55/67). Using either method, pus was obtained in 60.4% (n=189/313).
Telephone advice only was given by way of remote management in 6.6% of tonsillitis cases (n=50/759) and 3.6% of PTA cases (n=15/413).
For tonsillitis cases, when seen face to face (n=709), the majority of patients were reviewed by pre-specialty grade junior doctors (51.6%, n=366) followed by specialty grade junior doctors (40.2%, n=285), consultants (6.1%, n=43), and nurse practitioners (2.1%, n=15).
For PTA cases, when seen face to face (n=398), the majority of patients were reviewed by pre-specialty grade junior doctors (48.2%, n=192) followed by specialty grade junior doctors (41.2%, n=164), consultants (7.8%, n=31), and nurse practitioners (2.8%, n=11).

## Admission to hospital from ED

Tables 1 and 2 show the discharge rates for tonsillitis and PTA patients reviewed by ENT after presenting to the ED. The overall discharge rate was 54.4% for tonsillitis (n=410/754) and 45.3% for PTA (n=187/413). These data are also visualised in Figures 3 and 4.
Discharge rates from ED before and after statim IV medications were as follows: tonsillitis 17.6% (n=133/754) and 44.6% (n=277/754); PTA 9.0% (n=37/413) and 39.9% (150/376), respectively.
Length of stay data were available for all eligible patients admitted to hospital. Patients staying ≥1 day, ≥2 days and ≥3 days were as follows: tonsillitis 61.9%, 38.1%, 14.2% (n=213/344, 131/344, and 49/344) and PTA 61.9%, 38.1%, 12.4% (n=140/226, 86/226, and 28/226).

## Planned follow up for ED discharges

No follow-up was arranged in 71.7% of tonsillitis patients (n=294/410) with 5.9% having face-to-face (n=81/410) and 19.8% having telephone appointments scheduled (n=81/410) (9 reported as ‘other’, 2 directly listed for tonsillectomy).
No follow-up was arranged in 50.3% of PTA patients (n=94/187) with 8.6% having face-to-face (n=16/187) and 38.5% having telephone appointments scheduled (n=72/187) (5 reported as ‘other’).

## Unscheduled re-presentation within 10 days

Re-presentation rates and outcomes from re-presentation are shown in table 3. Further detail for ED discharges, by patient and management factors, are shown in tables 1 and 2.
Univariable logistic regression showed no significant predictors of re-presentation within 10 days (tables 1 and 2). No deaths were recorded.