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

Publication date: Available online 24 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Brian J. Christensen, Earl Peter Park, Steven Nelson, Brett J. King

Purpose

Pain and swelling from a necrotic tooth is a common complaint in emergency departments. These patients impose significant 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 imaging (CT) and specialist consultation in patients with odontogenic infections.

Methods

A retrospective case series was designed. Patients older than 18 years with an odontogenic infection presenting to the emergency department from 8/1/2012 to 4/30/2015 were eligible for inclusion in the study. Demographic, clinical, laboratory and treatment data was 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 was used to determine the necessity for the imaging and consultation. Descriptive statistics were used to analyze the data.

Results

There were 72 patients that met the inclusion criteria. The patients were 52.9% female and the mean age was 40.0 years. The decision to order CT imaging was made by the emergency medicine physicians for 61.7% of patients with infections that did not require CT imaging. Likewise, oral and maxillofacial surgery was consulted for 77.8% of the patients 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, inter-departmental collaboration, and conducting and disseminating peer-reviewed research are several ways to increase efficiency of care in patients with odontogenic infections.

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