Airway Intervention Is Significant in Ludwig’s Angina Management

What are the epidemiological characteristics of Ludwig’s angina patients who present to the emergency department (ED), and what are the outcomes and resources used?

Bottom Line: The mortality rate for Ludwig’s angina appears to be decreased from previous historical accounts, with airway intervention remaining a significant part of management.

Background: Ludwig’s angina is a rare, potentially life-threatening cellulitis of the submandibular space and mouth floor. Early recognition and airway management are crucial, as it can progress rapidly to airway obstruction, mediastinitis, and sepsis. Usual management involves intravenous antibiotics, surgical drainage of any fluid collection, and, when indicated, airway interventions such as intubation or a surgical airway procedure.

Study design: Retrospective case review of 5,855 patients who visited the ED between 2006 and 2014 and were admitted with a primary diagnosis of Ludwig’s angina.

Setting: Nationwide Emergency Department Sample (NEDS) database.

Synopsis: The median age was 43 years old, with 25% being uninsured. The proportion of patients with private insurance, Medicare, or Medicaid was 31.3%, 21.3%, and 22.4%, respectively. Overall mortality rate was 0.3%. Patients who died had a significantly higher mean age compared to those who survived. The higher mortality rate for females over males was statistically significant, but female sex was not a predictor of mortality. Age and having Medicare insurance status were the only predictors of mortality. Most patients presented to a metropolitan hospital, although there were no significant differences in mortality with regard to hospital type. Patients who died had a significantly longer mean length of stay compared to those who survived. Of the total patients, 466 received an airway intervention, with 194 of those requiring a surgical airway. No patients who received a surgical airway died, and the type of intervention did not lead to differences in mean length of stay.   

Citation: McDonnough JA, Ladzekpo DA, Yi I, et al. Epidemiology and resource utilization of Ludwig’s angina ED visits in the United States 2006–2014. Laryngoscope. 2019;129:2041–2044.