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Article: Adult acute epiglottitis: Predictors for airway intervention and intensive care unit admission

TitleAdult acute epiglottitis: Predictors for airway intervention and intensive care unit admission
Authors
KeywordsIntratracheal intubation
Adult
Risk factors
Airway obstruction
Issue Date2009
Citation
Hong Kong Journal of Emergency Medicine, 2009, v. 16, n. 4, p. 198-207 How to Cite?
AbstractObjectives: (1) to characterise the clinical features of acute epiglottitis in adults in Hong Kong; (2) to identify predictors for airway intervention and uneventful recovery without intensive care unit (ICU) admission. Modified Early Warning Score (MEWS) was also applied in risk stratification. Methods: A retrospective cohort study of 122 consecutive laryngoscopically confirmed cases admitted to Pamela Youde Nethersole Eastern Hospital from 1998 to 2007. Results: The mean patient age was 51 years (range 18-84 years) and the male-to-female ratio was 1.9 to 1. Sore throat, dysphagia and odynophagia were the commonest symptoms and the median MEWS on presentation was 1 (range 0-10). Nine patients (7.4%) required airway intervention (5 orotracheal intubations, 2 nasotracheal intubations and 2 tracheostomies) and one patient died. Univariate analysis showed that recurrent attack (OR 35.0, 95%CI 2.77-442.69, p=0.013), dyspnoea (OR 17.41, 95%CI 2.09-144.79, p=0.001), stridor (OR 30.0, 95%CI 2.42-372.65, p=0.016) and MEWS equal to or greater than 4 (OR 5.81. 95%CI 1.16-29.17, p=0.049) were significantly associated with airway intervention. Only stridor remained a reliable predictor in multivariate analysis (OR 88.46, 95%CI 5.48-1427.45, p=0.001). Performance of MEWS in prediction for airway intervention was evaluated with the Receiver Operating Characteristic (ROC) curve. The area under curve (AUC) was 0.71 (95%CI 0.503-0.909). Forty-five patients did not require ICU admission (36.9%). Multiple logistic regression showed that absence of hoarseness (OR 3.10, 95%CI 1.10-8.79, p=0.033), absence of fever (OR 3.2, 95%CI 1.25-8.16, p=0.015) and MEWS <1 (OR 7.07, 95%CI 1.31-38.07, p=0.023) were predictors of uneventful recovery without ICU care. Conclusion: A selective approach should be adopted in airway management but those with stridor on presentation should have their airway secured without delay. MEWS cannot replace clinical judgement but a low MEWS on presentation may help in identifying low risk patients who can be managed safely without ICU admission.
Persistent Identifierhttp://hdl.handle.net/10722/208895
ISSN
2015 Impact Factor: 0.153
2015 SCImago Journal Rankings: 0.173

 

DC FieldValueLanguage
dc.contributor.authorLam, Pui Kin-
dc.contributor.authorChoi, Yufai-
dc.contributor.authorWong, Taiwai-
dc.contributor.authorLau, Chorchiu-
dc.date.accessioned2015-03-23T02:02:05Z-
dc.date.available2015-03-23T02:02:05Z-
dc.date.issued2009-
dc.identifier.citationHong Kong Journal of Emergency Medicine, 2009, v. 16, n. 4, p. 198-207-
dc.identifier.issn1024-9079-
dc.identifier.urihttp://hdl.handle.net/10722/208895-
dc.description.abstractObjectives: (1) to characterise the clinical features of acute epiglottitis in adults in Hong Kong; (2) to identify predictors for airway intervention and uneventful recovery without intensive care unit (ICU) admission. Modified Early Warning Score (MEWS) was also applied in risk stratification. Methods: A retrospective cohort study of 122 consecutive laryngoscopically confirmed cases admitted to Pamela Youde Nethersole Eastern Hospital from 1998 to 2007. Results: The mean patient age was 51 years (range 18-84 years) and the male-to-female ratio was 1.9 to 1. Sore throat, dysphagia and odynophagia were the commonest symptoms and the median MEWS on presentation was 1 (range 0-10). Nine patients (7.4%) required airway intervention (5 orotracheal intubations, 2 nasotracheal intubations and 2 tracheostomies) and one patient died. Univariate analysis showed that recurrent attack (OR 35.0, 95%CI 2.77-442.69, p=0.013), dyspnoea (OR 17.41, 95%CI 2.09-144.79, p=0.001), stridor (OR 30.0, 95%CI 2.42-372.65, p=0.016) and MEWS equal to or greater than 4 (OR 5.81. 95%CI 1.16-29.17, p=0.049) were significantly associated with airway intervention. Only stridor remained a reliable predictor in multivariate analysis (OR 88.46, 95%CI 5.48-1427.45, p=0.001). Performance of MEWS in prediction for airway intervention was evaluated with the Receiver Operating Characteristic (ROC) curve. The area under curve (AUC) was 0.71 (95%CI 0.503-0.909). Forty-five patients did not require ICU admission (36.9%). Multiple logistic regression showed that absence of hoarseness (OR 3.10, 95%CI 1.10-8.79, p=0.033), absence of fever (OR 3.2, 95%CI 1.25-8.16, p=0.015) and MEWS <1 (OR 7.07, 95%CI 1.31-38.07, p=0.023) were predictors of uneventful recovery without ICU care. Conclusion: A selective approach should be adopted in airway management but those with stridor on presentation should have their airway secured without delay. MEWS cannot replace clinical judgement but a low MEWS on presentation may help in identifying low risk patients who can be managed safely without ICU admission.-
dc.languageeng-
dc.relation.ispartofHong Kong Journal of Emergency Medicine-
dc.subjectIntratracheal intubation-
dc.subjectAdult-
dc.subjectRisk factors-
dc.subjectAirway obstruction-
dc.titleAdult acute epiglottitis: Predictors for airway intervention and intensive care unit admission-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.scopuseid_2-s2.0-70349847480-
dc.identifier.volume16-
dc.identifier.issue4-
dc.identifier.spage198-
dc.identifier.epage207-

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