AIM: To assess whether CT scans for quinsy are over-utilized or a valuable tool in preventing patient transfers to higher-level hospitals. METHODOLOGY: Data was collected from patients diagnosed with ‘Tonsillitis’, ‘Acute tonsillitis’, ‘Quinsy’, or ‘Peritonsillar Abscess’ in Northern NSW over a 9.5-year period (2015– July 2025). Records from hospital presentations, diagnoses, and CT scans were analyzed. Transfers within 72 hours were considered part of a single encounter. RESULTS: A total of 17,519 records were reviewed. Among 356 patients transferred to higher-level hospitals, 65 of 297 (21.5%) underwent CT. After imaging, 9 patients’ diagnoses were downgraded from quinsy to tonsillitis, while 8 had their diagnosis upgraded from tonsillitis to quinsy. Of the 291 transferred patients who did not receive a CT, 127 retained a quinsy diagnosis, 79 were downgraded to tonsillitis, and 15 were upgraded to quinsy. Overall, 167 patients (0.95%) had CT scans, with 44 downgraded to tonsillitis, 46 confirmed with quinsy, and 8 upgraded from tonsillitis to quinsy. Of 456 patients who did not transfer and had repeated tonsillitis diagnoses, none developed quinsy. CT scans increased from 2 in 2015 to 36 in 2024, showing a statistically significant upward trend (p < 0.001). CONCLUSION: CT scans often downgraded diagnoses from quinsy to tonsillitis, potentially preventing transfers. Though a small fraction of cases involved CT, its use has grown significantly. Further cost analysis and protocol development are needed to assess decision-making and optimise CT use.