{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T16:31:21Z","timestamp":1788107481245,"version":"build-2803163510"},"reference-count":48,"publisher":"Royal College of General Practitioners","issue":"678","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Neither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>A retrospective cohort study of electronic medical records of children aged 0\u201315 years registered with 739 UK general practices contributing to a research database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Children with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy was then identified. The numbers with evidence-based and non-evidence-based indications for surgery among children who had undergone tonsillectomy were determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The authors included 1 630 807 children followed up for 7 200 159 person\u2013years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144\/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144\/18 281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: five to six sore throats (12.4%) in 1 year, two to four sore throats (44.6%) in 1 year, sleep disordered breathing (12.3%), or obstructive sleep apnoea (3.9%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the UK, few children with evidence-based indications undergo tonsillectomy and seven in eight of those who do (32 500 of 37 000 annually) are unlikely to benefit.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp18x699833","type":"journal-article","created":{"date-parts":[[2018,11,6]],"date-time":"2018-11-06T00:19:16Z","timestamp":1541463556000},"page":"e33-e41","source":"Crossref","is-referenced-by-count":48,"title":["Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records"],"prefix":"10.3399","volume":"69","author":[{"given":"Dana","family":"\u0160umilo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Nichols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronan","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2018,11,5]]},"reference":[{"key":"2020081209325162000_69.678.e33.1","unstructured":"Eurostat (2017) Surgical operations and procedures statistics, Statistics explained. http:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php\/Surgical_operations_and_procedures_statistics (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.2","doi-asserted-by":"publisher","DOI":"10.1177\/0194599810389949"},{"key":"2020081209325162000_69.678.e33.3","unstructured":"NHS Digital (2017) Hospital admitted patient care activity, 2016\u201317, https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/hospital-admitted-patient-care-activity\/2016-17 (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.4","unstructured":"The Dartmouth Atlas of Health Care (2018) Tonsillectomies per 1,000 children, http:\/\/www.dartmouthatlas.org\/data\/table.aspx?ind=296 (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-4486.2010.02086.x"},{"key":"2020081209325162000_69.678.e33.6","unstructured":"NHS England, Monitor (2016) 2016\/17 National tariff payment system. Annex A: 2016\/17 national prices and national tariff workbook, https:\/\/www.gov.uk\/government\/publications\/nhs-national-tariff-payment-system-201617 (accessed 3 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.7","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-017-0888-y"},{"key":"2020081209325162000_69.678.e33.8","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e318294fc47"},{"issue":"7","key":"2020081209325162000_69.678.e33.9","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1001\/jamaoto.2018.0614","article-title":"Association of long-term risk of respiratory, allergic, and infectious diseases with removal of adenoids and tonsils in childhood","volume":"144","author":"Byars","year":"2018","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2020081209325162000_69.678.e33.10","unstructured":"Royal College of Surgeons (2005) National prospective tonsillectomy audit final report, https:\/\/www.rcseng.ac.uk\/library-and-publications\/rcs-publications\/docs\/tonsillectomy-audit\/ (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.11","doi-asserted-by":"crossref","unstructured":"Burton MJ Glasziou PP Chong LY Venekamp RP (2014) Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic\/recurrent acute tonsillitis. Cochrane Database Syst Rev (11):CD001802.","DOI":"10.1002\/14651858.CD001802.pub3"},{"key":"2020081209325162000_69.678.e33.12","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-3490"},{"key":"2020081209325162000_69.678.e33.13","unstructured":"Chinnadurai S Sathe NA Morad A (2017) Tonsillectomy for obstructive sleep-disordered breathing or recurrent throat infection in children: a meta-analysis. Pediatrics 139(2), pii: e20163491."},{"key":"2020081209325162000_69.678.e33.14","unstructured":"Scottish Intercollegiate Guidelines Network (2010) 117. Management of sore throat and indications for tonsillectomy \u2014 a national clinical guideline, http:\/\/www.sign.ac.uk\/assets\/sign117.pdf (accessed 17 Oct 2018)."},{"issue":"5","key":"2020081209325162000_69.678.e33.15","first-page":"566","article-title":"AAO\u2013HNS guidelines for tonsillectomy in children and adolescents","volume":"84","author":"Randel","year":"2011","journal-title":"Am Fam Physician"},{"issue":"8","key":"2020081209325162000_69.678.e33.16","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1056\/NEJM197802232980801","article-title":"History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented","volume":"298","author":"Paradise","year":"1978","journal-title":"N Engl J Med"},{"key":"2020081209325162000_69.678.e33.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198403153101102"},{"key":"2020081209325162000_69.678.e33.18","doi-asserted-by":"publisher","DOI":"10.1542\/peds.110.1.7"},{"key":"2020081209325162000_69.678.e33.19","unstructured":"Burton MJ Pollard AJ Ramsden JD (2014) Tonsillectomy for periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA). Cochrane Database Syst Rev (9):CD008669."},{"key":"2020081209325162000_69.678.e33.20","doi-asserted-by":"publisher","DOI":"10.1308\/003588411X579793"},{"key":"2020081209325162000_69.678.e33.21","doi-asserted-by":"crossref","unstructured":"Venekamp RP Hearne BJ Chandrasekharan D (2015) Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev (10):CD011165.","DOI":"10.1002\/14651858.CD011165.pub2"},{"key":"2020081209325162000_69.678.e33.22","unstructured":"US National Library of Medicine , ClinicalTrials.gov. NCT02562040. Pediatric adenotonsillectomy for snoring (PATS). https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02562040 (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.23","unstructured":"US National Library of Medicine , ClinicalTrials.gov. NCT02315911. Randomized control trials of surgery for pediatric OSA. https:\/\/clinicaltrials.gov\/ct2\/show\/study\/NCT02315911 (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.24","unstructured":"World Health Organization (2017) International Clinical Trials Registry Platform. Search Portal. ChiCTR-TRC-10001136. Effect of adenotonsillectomy on behavioural problems in children with mild obstructive sleep apnoea: a randomized controlled trial. http:\/\/apps.who.int\/trialsearch\/Trial2.aspx?TrialID=ChiCTR-TRC-10001136 (accessed 25 Oct 2018)."},{"issue":"2","key":"2020081209325162000_69.678.e33.25","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jaad.2014.10.013","article-title":"Effect of tonsillectomy on psoriasis: a systematic review","volume":"72","author":"Rachakonda","year":"2015","journal-title":"J Am Acad Dermatol"},{"key":"2020081209325162000_69.678.e33.26","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfu020"},{"key":"2020081209325162000_69.678.e33.27","unstructured":"IQVIA (2018) The Health Improvement Network (THIN), https:\/\/www.iqvia.com\/locations\/uk-and-ireland\/thin (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.28","doi-asserted-by":"publisher","DOI":"10.14236\/jhi.v12i3.124"},{"key":"2020081209325162000_69.678.e33.29","first-page":"251","article-title":"Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates","volume":"19","author":"Blak","year":"2011","journal-title":"Inform Prim Care"},{"key":"2020081209325162000_69.678.e33.30","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1688"},{"key":"2020081209325162000_69.678.e33.31","unstructured":"Office for National Statistics (2017) Population estimates by single year of age and sex for local authorities in the UK, mid-2015, http:\/\/www.ons.gov.uk\/file?uri=\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/datasets\/populationestimatesforukenglandandwalesscotlandandnorthernireland\/mid2015\/ukmye2015.zip (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.32","unstructured":"NHS England (2013) High quality care for all, now and for future generations: Transforming urgent and emergency care services in England. The evidence base from the urgent and emergency care review, https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2013\/06\/urg-emerg-care-ev-bse.pdf (accessed 17 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.33","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmv003"},{"key":"2020081209325162000_69.678.e33.34","doi-asserted-by":"crossref","unstructured":"van den Aardweg MT Schilder AG Herkert E (2010) Adenoidectomy for otitis media in children. Cochrane Database Syst Rev (1):CD007810.","DOI":"10.1002\/14651858.CD007810.pub2"},{"key":"2020081209325162000_69.678.e33.35","doi-asserted-by":"publisher","DOI":"10.3205\/cto000136"},{"issue":"1","key":"2020081209325162000_69.678.e33.36","first-page":"23","article-title":"How many tonsillectomies are evidence-based?","volume":"3","author":"Marshall","year":"2001","journal-title":"J Clin Excellence"},{"issue":"3","key":"2020081209325162000_69.678.e33.37","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/coa.12098","article-title":"Sore throat consultations in general practice prior to tonsillectomy among eight hundred and sixty-three children in England: is this in accordance with the SIGN guidelines?","volume":"38","author":"Koshy","year":"2013","journal-title":"Clin Otolaryngol"},{"issue":"1","key":"2020081209325162000_69.678.e33.38","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1308\/rcsann.2016.0261","article-title":"Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis","volume":"99","author":"Yap","year":"2017","journal-title":"Ann R Coll Surg Eng"},{"key":"2020081209325162000_69.678.e33.39","unstructured":"Windfuhr JP (2016) Specified data for tonsil surgery in Germany. GMS Curr Top Otorhinolaryngol Head Neck Surg 15:Doc08."},{"key":"2020081209325162000_69.678.e33.40","unstructured":"British Academic Conference in Otolaryngology and British Association of Otorhinolaryngology \u2014 Head & Neck Surgery (2009) Indications for tonsillectomy: Position paper ENT UK, http:\/\/www.albert.uk.com\/fileadmin\/user_upload\/Uploaded_files\/tmp\/david_albert\/david_albert_pdf\/tonsillectomy_position_papers_09.pdf (accessed 25 Oct 2018)."},{"key":"2020081209325162000_69.678.e33.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.01.044"},{"key":"2020081209325162000_69.678.e33.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2010.11.019"},{"issue":"1","key":"2020081209325162000_69.678.e33.43","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1001\/jamainternmed.2017.4361","article-title":"2017 Update on medical overuse: A systematic review","volume":"178","author":"Morgan","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2020081209325162000_69.678.e33.44","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.5752"},{"key":"2020081209325162000_69.678.e33.45","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0067611"},{"key":"2020081209325162000_69.678.e33.46","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.5057"},{"issue":"17","key":"2020081209325162000_69.678.e33.47","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1001\/jamainternmed.2013.8992","article-title":"Worsening trends in the management and treatment of back pain","volume":"173","author":"Mafi","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2020081209325162000_69.678.e33.48","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-3107-3"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/bjgp18X699833","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T19:50:11Z","timestamp":1645818611000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjgp.org\/lookup\/doi\/10.3399\/bjgp18X699833"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,5]]},"references-count":48,"journal-issue":{"issue":"678","published-online":{"date-parts":[[2018,12,27]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.3399\/bjgp18X699833"],"URL":"https:\/\/doi.org\/10.3399\/bjgp18x699833","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,5]]}}}