Adult Epiglottitis in a Canadian Setting

Authors

  • Paul C. Hébert MD, FRCPC, MHSc,

    Corresponding author
    1. Critical Care Program, University of Ottawa, Ontario, Canada
    2. Clinical Epidemiology Unit, University of Ottawa, Ontario, Canada
    Current affiliation:
    1. Dr. Hébert is a career scientist of the Ontario Ministry of Health.
    • Paul C. Hébert MD, FRCPC, MHSc, Department of Medicine, Division of Respiratory Medicine, Room LM11, Ottawa General Hospital, 501 Smyth Road, Ottawa, Ontario, Canada, K1H 8L6.
    Search for more papers by this author
  • Yadranko Ducic MD,

    1. Department of Otolaryngology, University of Texas Southwestern Medical School, Dallas, Texas.
    Search for more papers by this author
  • Denis Boisvert MSc,

    1. Clinical Epidemiology Unit, University of Ottawa, Ontario, Canada
    Search for more papers by this author
  • André Lamothe MD, FRCSC

    1. Clinical Epidemiology Unit, University of Ottawa, Ontario, Canada
    Search for more papers by this author

  • Presented in part at the Annual Meeting of the American College of Chest Physicians, 1994; the Annual Meeting of the Canadian Society of Otolaryngology-Head and Neck Surgery, 1994; and the Annual Meeting of the American Thoracic Society, 1995.

Abstract

The objective of this study was to determine stable estimates of the incidence, case fatality, and epidemiologic features of adult epiglottitis, and risk factors for intubation. The authors designed a retrospective cohort combined with a nested casecontrol study, followed by detailed analysis of cases from two tertiary care institutions. Among 813 cases, the incidence was 2.02 cases/105 population per year. Ten recorded deaths constituted a case fatality rate of 1.2% (95% confidence interval [CI]: 0.5% to 1.9%). The eight fully documented deaths indicated no sudden episodes of catastrophic upper airway obstructions without previous dyspnea. A detailed review of 51 cases revealed that 18% of patients underwent expeditious intubation. Patients managed without initially requiring intubation did not need emergency airway interventions. Only the presence of dyspnea (noted in 29% of patients) at the time of admission (P< 0.001) predicted the need for intubation. A low case fatality rate in a conservatively managed cohort and the absence of sudden upper airway catastrophes in patients without dyspnea suggest that prophylactic intubation and intensive care unit monitoring is not warranted in all patients. An early complaint of dyspnea may safely discriminate between patients requiring invasive airway management and close observation.

Ancillary