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

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.