Epiglottitis Is Significant ED Pathology, Carries Mortality Risk

What are the trends and mortality of adult epiglottitis presenting to the emergency department (ED)?

Bottom line
Epiglottitis is still a significant pathology seen in EDs, is stable over the study period, and carries a mortality risk. There is an exceptionally low rate of documented clinical interventions in the ED.

Background: Although traditionally regarded as a young children’s disease, epiglottitis in the postvaccine era has comprised mostly of adult cases that usually present through the ED. More of these patients present with sore throat and odynophagia rather than the classic symptoms of drooling and stridor. Older studies report mortality rates in adults at 6% to 7%, but more recent rates are difficult to find in the literature.

Study design: Database study of 33,549 nationally representative cases (average of 4,194 per year)

Setting: Nationwide Emergency Department Sample from 2007 to 2014.

Synopsis: From 2007 to 2014, the percentage of patients paying with Medicare and Medicaid steadily increased. Overall, most patients paid with private insurance, followed by Medicare,
Medicaid, and self-pay. Regionally, the South had the most cases. Large metropolitan hospitals had the largest proportion of cases, while nonmetropolitan and nonmicropolitan had the smallest. A total of 11.8% of patients were coded as epiglottitis with obstruction. Across all years, <1% of patients with epiglottitis received laryngoscopic or airway procedures in the ED. The rate of imaging utilization was less than 10% each year for both X-ray and CT. Aggregated across all years, 22 patients died in the ED versus 317 who subsequently died in the hospital. On univariate analysis, the following factors were significantly associated with mortality: all patient factors, all facility factors except region, and only obstruction from clinical factors. Mortality was higher in obstructed, older male smokers with multiple comorbidities. Patients with Medicare and lower incomes had a higher mortality risk. Patients treated at level II trauma centers faired the best, whereas those at level III had the worst outcomes.

Citation: Hanna J, Brauer PR, Berson E, Mehra S. Adult epiglottitis: trends and predictors of mortality in over 30 thousand cases from 2007 to 2014.
Laryngoscope. 2019;129:1107–1112.