Overutilization of Computed Tomography for Odontogenic Infections

Publication date: Available online 7 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ashleigh Weyh, Evan Busby, Salam O. Salman, Carmen Smotherman, Shiva Gautam

Abstract

Purpose

There is clear overutilization of computed tomography (CT) in the emergency setting, which is associated with a long-term potential for malignancy. This study aims to determine the rate of overutilization of CT for odontogenic infection work up, and determine the correlation of findings on the history and physical to diagnose moderate to high risk infections.

Methods

A retrospective cross-sectional study was implemented to determine the rate of overutilization of CT for odontogenic infections. Included subjects presented through the emergency department (ED) for evaluation of an odontogenic infection. A CT was determined to be unnecessary if the subjects presented without "red flag" signs on physical exam, which included voice change, elevated floor of mouth, signs of inflammation of deep fascial spaces, periorbital edema, non-palpable inferior border of the mandible, dyspnea, dysphagia/odynophagia, and trismus. Subjects could have no evidence of involvement of a moderate to high risk space or airway change on CT. Infection severity was either low, moderate, or high risk based on anatomical proximity to the airway and critical structures. Sensitivity, specificity, positive predictive, and negative predictive values of the history and physical (H&P) findings to predict moderate to high risk infections were calculated, with 95% confidence intervals.

Results

470 subjects were included, and 389 total CTs were performed, with 220 (56.6%) being unnecessary. Unnecessary scans were most prevalent in subjects with low risk infections, where out of 284 total CTs performed, 222 (78.2%) were unnecessary. There was high correlation of "red flag" signs with moderate to high risk infections.

Conclusion

There is overutilization of CT for odontogenic infections, most prevalent in low risk infections without significant findings in the work up. H&P findings can help accurately diagnose a higher risk infection prior to subjecting a patient to CT.

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