Adult epiglottitis: Trends and predictors of mortality in over 30 thousand cases from 2007 to 2014

Abstract

Objectives To characterize trends of adult epiglottitis presenting to the emergency department (ED) and analyze mortality. Methods We utilized the National Emergency Department Sample to characterize adult epiglottitis from 2007 to 2014 and used provided weights to obtain nationally representative data (all presented data are weighted). Univariate and multivariate analyses were conducted to determine predictors of mortality. Results A total of 33,549 cases were identified (weighted). Over the study period, the average patient age increased significantly from 47 to 51 (R2 > 0.5), with an overall mean age of 49. A total of 11.8% of patients were coded as having obstruction, and 68.3% of cases were admitted to the hospital. Across all years, < 1% received laryngoscopic or airway procedures in the ED. Utilization of both X‐ray and computed tomography was <10%. Over the 8 years, there were an average of 42 deaths per year (1.01% overall mortality). No clinical factors, except obstruction, were significant on univariate analysis (P < 0.05). Multivariate analysis indicated that patient age, degree of hospital urbanization, and smoking status also were nonsignificant. Conclusions Epiglottitis is still a significant pathology seen in EDs, is stable over the study period, and carries a mortality risk. There is an exceptionally low rate of documented clinical interventions in the ED, especially compared with inpatient studies of epiglottis. This suggests a lack of recognition of the need and utilization of critical airway interventions early in the patient encounter. Future research is needed to characterize the reasons for the low rate of early airway visualization and intervention of epiglottitis in the ED. Level of Evidence 4 Laryngoscope, 129:1107–1112, 2019

Angioedema Masqueraders

“…84 It may be infectious in nature, caused by a variety of organisms, including Haemophilus influenzae type B and Streptococcus pneumoniae. 84 It may be infectious in nature, caused by a variety of organisms, including Haemophilus influenzae type B and Streptococcus pneumoniae.…”

“…Epiglottitis is a significant pathology seen in the emergency department, and it carries a mortality risk. 84 It may be infectious in nature, caused by a variety of organisms, including Haemophilus influenzae type B and Streptococcus pneumoniae. It may also be caused by mechanical injury or inhalation of hot objects.…”

Associations between Male Gender, Body Size and Dimension of the Epiglottis

“…However, acute epiglottitis has become a disease of adultsin the post-vaccine era, approximately 4,000 new cases per year reported in the United States 4 . The mortality rates were reported from 1% to 7% 5,6 . Therefore, early recognition and accurate diagnosis for adult patients are required in emergency settings.…”

“…The diagnosisof acute epiglottitis is based on clinical symptoms, radiography, and laryngoscopy examination 7,8 . Sore throat and odynophagia are the common symptoms 5 . Laryngoscopy is regarded as thegold standard for diagnosis 9 .However,laryngoscopy has limitations, suchas invasiveness, inconvenience, and procedure-related airway obstruction 10 .During the COVID-19 pandemic, it represents aninfection risk for patients and a high occupational hazard for otolaryngologists involved with the procedure 11 .…”

“…Laryngoscopy is regarded as thegold standard for diagnosis 9 .However,laryngoscopy has limitations, suchas invasiveness, inconvenience, and procedure-related airway obstruction 10 .During the COVID-19 pandemic, it represents aninfection risk for patients and a high occupational hazard for otolaryngologists involved with the procedure 11 . Also, less than 10% of patients with acute epiglottitis received laryngoscopy in a large-scale study 5 . Lateral neckradiographs are oftenused for screening in emergency departments (EDs) for suspectedacute epiglottitis 12 .…”