Airway management in pediatric epiglottitis: A national perspective

Department of Otolaryngology, Head and Neck Surgery, National Capitol Consortium, Washington, DC, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 1.72). 05/2009; 140(4):548-51. DOI: 10.1016/j.otohns.2008.12.037
Source: PubMed

ABSTRACT The purpose of this study was to describe current demographics and resource utilization in the treatment of pediatric epiglottitis.
Case series from a national database.
The Kids' Inpatient Database was systematically searched to extract patients under 19 years old admitted with a diagnosis of epiglottitis and undergoing an airway intervention.
Three hundred forty-two sampled admissions were for epiglottitis; 40 of these patients were under the age of 19 and had an airway intervention (intubation or tracheotomy). On average, patients were 4.3 years old (SD = 6.0 years). The average length of stay was 15.6 days (SD = 33.9 and range = 0-199) with average total charges of $74,931 (SD = $163,387, range = $3342-$938,512). Multivariate analysis revealed that admission to a children's facility, admission other than via the emergency room, and nonemergent admission were associated with increased total charges. Twenty-two states reported an admission for pediatric epiglottitis that required airway intervention.
In our sample, only 40 patients were identified who were under the age of 19 years and required an airway intervention for the treatment of epiglottitis. Epiglottitis is a rare, expensive, and protracted disease to treat in the postvaccine era. The unique nature of this disease has implications for training future surgeons on proper management of this potentially fatal disease.


Available from: Jason L Acevedo, Apr 29, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction This study aimed to assess the differences in the clinical characteristics, management, and outcomes of supraglottitis between geriatric and non-geriatric adults over a 30-month period. Methods All adult patients admitted to the emergency department (ED) with suspected supraglottitis and who underwent laryngoscopy for confirmation were included. We collected the clinical characteristics, management, and outcomes of these patients and compared geriatric (≥ 60 years old) and non-geriatric (12-59 years old) groups in terms of these data. Results Eighty-one geriatric patients and 205 non-geriatric patients were reviewed during the study period. The accuracies of the clinical suspicions of supraglottitis were lower in the geriatric group (geriatric vs. non-geriatric, 29.4% vs. 47.3%, p = 0.008). The geriatric group constituted 19.8% of all supraglottitis patients. Comorbidities were discovered in 74.1% of the geriatric group and 25.4% of the non-geriatric group (p = 0.000). The complication rate in the geriatric patients was almost twice that of the non-geriatric patients (20.8% vs. 10.8%). Additionally, the geriatric patients exhibited tendencies toward longer periods of intubation, hospitalization, and stay in the intensive care unit (ICU). Conclusions The clinical characteristics and management were similar between the geriatric and non-geriatric supraglottitis patients. Nevertheless, the comorbidities altered the clinical presentations of the geriatric patients and resulted in lower diagnostic accuracy. Additionally, the elevated complication rates of the geriatric patient might have negatively affected their outcomes.
    American Journal of Emergency Medicine 08/2014; 32(11). DOI:10.1016/j.ajem.2014.08.033 · 1.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Epiglottitis is a potentially life-threatening disease and is largely preventable by vaccination against Haemophilus influenzae type b (Hib). Little is known, however, about the epidemiology of childhood epiglottitis in Asian countries, including Japan. Using a nationwide inpatient database, this study aimed to determine the burden of childhood epiglottitis before the introduction of Hib vaccine into Japan. The study period was between July and December in 2007 and 2008, when Hib vaccine was not available. We found 102 cases with epiglottitis among children ≤5 years old. The annual incidence of epiglottitis in children ≤5 years old was estimated to be 3.2 per 100,000 population per year. Among the 102 patients, 31 (30.4 %) required respiratory support, including two cases with tracheotomy and one fatal case. Our study demonstrated the substantial burden of epiglottitis among Japanese children, highlighting that a routine Hib vaccination program is essential.
    Journal of Infection and Chemotherapy 03/2013; DOI:10.1007/s10156-013-0585-x · 1.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives/Hypothesis:To study national trends, variances, and outcomes in patients admitted with epiglottitis in the United States. We hypothesize that the incidence of epiglottitis has decreased, mortality has decreased, and that there has been a shift toward older patients being admitted with epiglottitis.Study Design:Retrospective review of a dataset for years 1998, 2000, 2002, 2004, and 2006.Methods:The Nationwide Inpatient Sample was searched using ICD-9 CM codes for epiglottitis with obstruction (464.30) and without obstruction (464.31). Characteristics studied included patient demographics, hospital information, and admission variables. Weighted admissions were analyzed to facilitate national estimates.Results:There was a trend toward decreasing admissions over the study period, from 4587.17 cases (1998) to 3772.49 cases (2006); the mean over the study period was 4062.52 cases/year. The mean age of a patient with epiglottitis has remained relatively constant at 44.94 years over the study period; there are less frequent admissions in the 18 years and younger age cohorts, with an increase in the ages 45 to 64 years old and in patients over 85 years old. Mean length of stay is 4.15 days. Mean total charges for an admission of epiglottitis was $17,204.02 (standard deviation, $5,894). There was a trend toward increased total charges for the management of epiglottitis from total charges of $10,738.60 (1998) to $25,071.62 (2006). The South had a predominantly higher proportion of epiglottitis admissions during the study period. The gender distribution remained consistent over the study years at approximately 60:40 for males:female. Mortality remained constant at approximately 36 cases per year for a national mortality rate from epiglottitis of 0.89%. The month with the highest percentage of admissions was December; April was the month with the lowest. The majority of admissions were via the emergency department; patients were transferred in 2.88% of admissions. Over two thirds of admissions were Caucasian patients. Hospital level measures included the majority of patients were treated in an urban hospital location (82%); a minority (41%) were treated at a teaching hospital. Insurance status was private insurance in 50.02%, Medicare 20.84%, and Medicaid 12.46%. The proportion of patients that were intubated was 13.18%; 3.62% underwent a tracheotomy. Additional diagnoses in admitted patients included concomitant cardiovascular (38.75%), infectious (27.17%), respiratory (22.88%), diabetes (13.26%), and substance abuse (18.86%) diagnoses.Conclusions:An 8-year retrospective review of epiglottitis admissions revealed that epiglottitis continues to be a significant clinical entity in the United States. The portrait of a typical patient that will be admitted with epiglottitis is a mid–40-year-old, Caucasian, urban, male, with comorbid medical conditions, who will remain in the hospital on average for 4 days, resulting in total charges of $25,072 (2006 dollars). The majority of the mortalities are in adult patients. The majority of patients with epiglottitis has significant medical comorbid conditions and will be managed at the admitting hospital and not be transferred. This series identifies two newly recognized and uniquely vulnerable populations for epiglottitis: infants (<1 year old) and the elderly (patients >85 years old). Laryngoscope, 2010
    The Laryngoscope 01/2010; 120(6):1256 - 1262. DOI:10.1002/lary.20921 · 2.03 Impact Factor