Epidemiology and resource utilization of ludwig's angina ED visits in the United States 2006–2014

Abstract

Objectives Ludwig's angina is a potentially lethal submandibular space infection. We aim to describe the epidemiological characteristics of Ludwig's angina patients presenting to the emergency department (ED) and to examine outcomes and resource utilization to determine their burden on ED and hospitals. Methods Using the Nationwide Emergency Department Sample database, a nationally representative all‐payer database, we retrospectively reviewed all ED visits between 2006 and 2014 for patients admitted with a primary diagnosis of Ludwig's angina (International Classification of Diseases, Ninth Revision, 528.3). We collected information including demographics, ED and inpatient charges, airway interventions, length of stay, and mortality. Results A total of 5,855 patients met our inclusion criteria. In our study population, the mean age was 44.5 years, with 54% males and 46% females. There were 75% insured and 25% uninsured. Overall median ED charges were $1,352 and median inpatient charges were $18,017.54, with a median length of stay of 3 days. As part of their management, 47.2% of the patients received a surgical drainage procedure, 3.3% required a surgical airway, and 4.6% required a nonsurgical airway. The overall mortality rate was 0.3%. Conclusion Ludwig's angina remains a rare and potentially life‐threatening condition. The mortality rate appears to be decreased from previous historical accounts, with airway intervention remaining a significant part of management. Level of Evidence 3 Laryngoscope, 129:2041–2044, 2019

Angina de Ludwig associada a complicações mediastinais: Relato de caso

“…O potencial letal da AL pode ser justificado pela rápida evolução do quadro infeccioso, acometendo os espaços faciais e bainhas vasculares, progredindo até atingir as áreas cervicais e glote. Ao alcançar o espaço faríngeo lateral e retro faríngeo, pode acometer o mediastino, causando a mediastinite aguda (Mcdonnough, et al, 2019;Bernardoni, et al, 2017;Dib, et al, 2016). O envolvimento do mediastino deve ser investigado em pacientes com AL que apresentem alterações respiratórias, como dispneia ou angústia respiratória e dor torácica (Dib, et al, 2016).…”

“…A angina de Ludwig (AL) descrita em 1836 por Wilhelm Frederick Von Ludwig é considerada uma situação infecto-inflamatório, de envolvimento polimicrobiano, que acomete áreas anatômicas submandibulares bilaterais, sublinguais e submentoniana (Bernardoni, et al, 2017;Mcdonnough, et al, 2019). Pode representar uma exacerbação de um processo infeccioso de origem dentária, traumatismo ósseo, laceração tecidual, acometimento por corpo estranho, amigdalite e fatores idiossincráticos (Cardoso, et al, 2020;Miller, et al, 2018).…”

“…As condutas iniciais para casos de AL devem ser rápidas, criteriosas e sequenciais (Manasia, et al, 2016;Pereira, et al, 2019). A manutenção da via aérea é fundamental, devido ao risco de rápida obstrução e, consequentemente, morte (Miller, et al, 2018;Mcdonnough, et al, 2019;Fernandes, et al, 2020). O tratamento inicial é feito por meio de terapia com antimicrobianos de amplo espectro, intravenosos, além da remoção de fatores etiológicos e, se necessária, drenagem cirúrgica (Lee, et al, 2019;Bernardoni, et al, 2017;Edetanlen & Saheeb, 2018).…”

“…O envolvimento dos espaços sublingual e submandibular pode, em razão de sua proximidade com as vias aéreas faringiana e laringeana, obstruí-las (Bross-Soriano, et al 2004). Outras possíveis complicações descritas na literatura são sepse, mediastinite descendente, infecção da bainha carotídea; abscesso subfrênico, síndrome de Lemierre ou tromboflebite da veia jugular interna, empiema e osteomielite de mandíbula (Mcdonnough, et al, 2019;Bernardoni, et al, 2017).…”

A Severe Case of Ludwig’s Angina with a Complicated Clinical Course

“…Other complications include mediastinitis, carotid artery rupture, internal jugular vein thrombophlebitis, empyema, necrotizing fasciitis, osteomyelitis, and aspiration pneumonia [7]. The reported mortality rates range from 0.3% to 11.8% [6,8]. Patients usually present with fever, pain, and swelling of the floor of the mouth.…”