Acute epiglottitis in adults. Analysis of 129 cases
T. D. Frantz, B. M. Rasgon and C. P. Quesenberry Jr
Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, CA 94611-5693.
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.
