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Analysis of 129 Cases

Timothy D. Frantz, MD; Barry M. Rasgon, MD; Charles P. Quesenberry, Jr, PhD

JAMA. 1994;272(17):1358-1360.

Abstract
Objective.
—To characterize the clinical features of acute epiglottitis in adults and to identify factors associated with airway intervention.

Design.
—Case series.

Setting.
—Northern California health maintenance organization.

Participants.
—A total of 129 patients aged 18 years or older with laryngoscopically confirmed acute epiglottitis admitted from November 1986 through October 1991.

Results.
—The mean patient age was 47 years (range, 18 to 85 years) and the male-to-female ratio was 1.8 to 1.0 (P<.001). The most common symptoms were sore throat (95%) and odynophagia (94%); the most common signs were muffled voice and evidence of pharyngitis. Nineteen patients (15%) received airway intervention, including seven with tracheotomy and 12 with endotracheal intubation. The remaining 110 patients recovered fully without airway intervention. In multivariate analysis, factors associated with airway intervention were stridor (relative risk [RR], 6.2; 95% confidence interval [CI], 1.7 to 22.9) and sitting erect (RR, 4.8; 95% CI, 1.3 to 16.1). Six (12%) of 52 blood cultures yielded Haemophilus influenzae type b. Major complications occurred in six patients (5%), but no deaths occurred.

Conclusion.
—Most adults who have acute epiglottitis can be managed conservatively and have low morbidity and mortality.

(JAMA. 1994;272:1358-1360)

Author Affiliations
From the Department of Head and Neck Surgery (Drs Frantz and Rasgon), Kaiser Permanente Medical Center, and the Division of Research (Dr Quesenberry), Kaiser Permanente Medical Care Program, Oakland, Calif. Dr Frantz is currently practicing in Red Bluff, Calif.

Footnotes
Reprint requests to Department of Head and Neck Surgery, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693 (Dr Rasgon).

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