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Lin YT, Shia BC, Chang CJ, Wu Y, Yang JD, Kang JH. Using Transfer Learning of Convolutional Neural Network on Neck Radiographs to Identify Acute Epiglottitis. J Digit Imaging 2023; 36:893-901. [PMID: 36658377 PMCID: PMC10287858 DOI: 10.1007/s10278-023-00774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
Acute epiglottitis (AE) is a life-threatening condition and needs to be recognized timely. Diagnosis of AE with a lateral neck radiograph yields poor reliability and sensitivity. Convolutional neural networks (CNN) are powerful tools to assist the analysis of medical images. This study aimed to develop an artificial intelligence model using CNN-based transfer learning to identify AE in lateral neck radiographs. All cases in this study are from two hospitals, a medical center, and a local teaching hospital in Taiwan. In this retrospective study, we collected 251 lateral neck radiographs of patients with AE and 936 individuals without AE. Neck radiographs obtained from patients without and with AE were used as the input for model transfer learning in a pre-trained CNN including Inception V3, Densenet201, Resnet101, VGG19, and Inception V2 to select the optimal model. We used five-fold cross-validation to estimate the performance of the selected model. The confusion matrix of the final model was analyzed. We found that Inception V3 yielded the best results as the optimal model among all pre-train models. Based on the average value of the fivefold cross-validation, the confusion metrics were obtained: accuracy = 0.92, precision = 0.94, recall = 0.90, and area under the curve (AUC) = 0.96. Using the Inception V3-based model can provide an excellent performance to identify AE based on radiographic images. We suggest using the CNN-based model which can offer a non-invasive, accurate, and fast diagnostic method for AE in the future.
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Affiliation(s)
- Yang-Tse Lin
- Department of Emergency Medicine, Hsinchu Cathay General Hospital, 30060, Hsinchu City, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City, 242062, Taiwan
| | - Chia-Jung Chang
- Division of Pediatric Emergency, Department of Pediatrics, MacKay Children's Hospital and Mackay Memorial Hospital, No. 92, Sec.2, Zhongshan N Road, Taipei City, 10449, Taiwan
| | - Yueh Wu
- Department of Orthopedics, Taipei Municipal Wanfang Hospital, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116081, Taiwan
| | - Jheng-Dao Yang
- Department of Physical Medicine and Rehabiliation, Taipei Medical University Hospital, No. 252 WuHsing Street, 110, Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabiliation, Taipei Medical University Hospital, No. 252 WuHsing Street, 110, Taipei City, Taiwan.
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, No. 250, Wuxing StXinyi Dist., Taipei City, 110301, Taiwan.
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing StXinyi Dist., 110301, Taipei City, Taiwan.
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2
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Duclos M, Hommel B, Allantaz F, Powell M, Posteraro B, Sanguinetti M. Multiplex PCR Detection of Respiratory Tract Infections in SARS-CoV-2-Negative Patients Admitted to the Emergency Department: an International Multicenter Study during the COVID-19 Pandemic. Microbiol Spectr 2022; 10:e0236822. [PMID: 36154273 PMCID: PMC9603986 DOI: 10.1128/spectrum.02368-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/02/2022] [Indexed: 01/04/2023] Open
Abstract
Respiratory tract infection (RTI) is a common cause of visits to the hospital emergency department. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), nonpharmaceutical intervention has influenced the rates of circulating respiratory viruses. In this study, we sought to detect RTI etiological agents other than SARS-CoV-2 in emergency department patients from 13 countries in Europe, the Middle East, and Africa from December 2020 to March 2021. We sought to measure the impact of patient characteristics and national-level behavioral restrictions on the positivity rate for RTI agents. Using the BioFire Respiratory Panel 2.0 Plus, 1,334 nasopharyngeal swabs from patients with RTI symptoms who were negative for SARS-CoV-2 were tested. The rate of positivity for viral or bacterial targets was 36.3%. Regarding viral targets, human rhinovirus or enterovirus was the most prevalent (56.5%), followed by human coronaviruses (11.0%) and adenoviruses (9.9%). Interestingly, age stratification showed that the positivity rate was significantly higher in the children's group than in the adults' group (68.8% versus 28.2%). In particular, human rhinovirus or enterovirus, the respiratory syncytial virus, and other viruses, such as the human metapneumovirus, were more frequently detected in children than in adults. A logistic regression model was also used to determine an association between the rate of positivity for viral agents with each country's behavioral restrictions or with patients' age and sex. Despite the impact of behavioral restrictions, various RTI pathogens were actively circulating, particularly in children, across the 13 countries. IMPORTANCE As SARS-CoV-2 has dominated the diagnostic strategies for RTIs during the current COVID-19 pandemic situation, our data provide evidence that a variety of RTI pathogens may be circulating in each of the 13 countries included in the study. It is now plausible that the COVID-19 pandemic will one day move forward to endemicity. Our study illustrates the potential utility of detecting respiratory pathogens other than SARS-CoV-2 in patients who are admitted to the emergency department for RTI symptoms. Knowing if a symptomatic patient is solely infected by an RTI pathogen or coinfected with SARS-CoV-2 may drive timely and appropriate clinical decision-making, especially in the emergency department setting.
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Affiliation(s)
| | | | | | | | - Brunella Posteraro
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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3
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Bridwell R, Koyfman A, Long B. Important considerations in adult epiglottitis. Am J Emerg Med 2022; 58:306. [PMID: 35701267 DOI: 10.1016/j.ajem.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Rachel Bridwell
- Department of Emergency Medicine, Madigan Medical Center, Tacoma, WA, United States of America
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, United States of America
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, United States of America.
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4
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High risk and low prevalence diseases: Adult epiglottitis. Am J Emerg Med 2022; 57:14-20. [PMID: 35489220 DOI: 10.1016/j.ajem.2022.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022] Open
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Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:65-70. [PMID: 35181262 DOI: 10.1016/j.redare.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/26/2021] [Indexed: 06/14/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
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Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
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6
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Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00109-2. [PMID: 34544597 DOI: 10.1016/j.redar.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 06/13/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
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Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
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7
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Akhavan M. Ear, Nose, Throat: Beyond Pharyngitis: Retropharyngeal Abscess, Peritonsillar Abscess, Epiglottitis, Bacterial Tracheitis, and Postoperative Tonsillectomy. Emerg Med Clin North Am 2021; 39:661-675. [PMID: 34215408 DOI: 10.1016/j.emc.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities described in this article include retropharyngeal abscess, peritonsillar abscess, epiglottitis, bacterial tracheitis, and post-tonsillectomy bleeding. This article provides the emergency physician with the tools needed to decipher between the mundane and the critical, variations in presentation, and their emergent management. All of them require early recognition for any airway compromise or obstruction in order to avoid serious complications.
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Affiliation(s)
- Mahsa Akhavan
- Goryeb Children's Hospital, Morristown Medical Center/Atlantic Health System, 100 Madison Ave, Morristown, NJ 07960, USA.
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8
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Leedman SR, Hendriks T, Leahy TW, Hall D. Supraglottic laryngeal sarcoidosis masquerading as supraglottitis. BMJ Case Rep 2020; 13:13/1/e232369. [PMID: 31937627 DOI: 10.1136/bcr-2019-232369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a rare multisystem disorder of unknown aetiology characterised by non-caseating granulomas in involved organs; it is a diagnosis of exclusion. Laryngeal involvement affects only 0.5%-5% of those with sarcoidosis. It is an uncommon but important cause of supraglottic inflammation and oedema and should be considered in the differential diagnosis in patients with supraglottitis. This case describes a 30-year-old man who presented with stridor and shortness of breath. Flexible nasendoscopic examination revealed a grossly oedematous, pale pink, diffusely hypertrophied epiglottis. Surgical biopsy revealed non-caseating granulomatous inflammation. In the context of exclusion of hepatitis, anti-neutrophil cytoplasmic antibody (ANCA) positivity, malignancy and mycobacterial infection, the diagnosis of supraglottic laryngeal sarcoid was made. He is being treated with azathioprine immunosuppression with symptomatic improvement.
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Affiliation(s)
- Samuel Robert Leedman
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Thomas Hendriks
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Travis William Leahy
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - David Hall
- Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
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9
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Latona A, Latona A. Meningococcal epiglottitis in a healthy adult patient: The first documented case in Australia. Emerg Med Australas 2018; 30:591-592. [DOI: 10.1111/1742-6723.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Akmez Latona
- Emergency Department; Ipswich General Hospital; Ipswich Queensland Australia
| | - Ashraaf Latona
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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10
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Gottlieb M, Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. J Emerg Med 2018. [PMID: 29523424 DOI: 10.1016/j.jemermed.2018.01.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pharyngitis is a common disease in the emergency department (ED). Despite a relatively low incidence of complications, there are many dangerous conditions that can mimic this disease and are essential for the emergency physician to consider. OBJECTIVE This article provides a review of the evaluation and management of group A β-hemolytic Streptococcal (GABHS) pharyngitis, as well as important medical conditions that can mimic this disease. DISCUSSION GABHS pharyngitis often presents with fever, sore throat, tonsillar exudates, and anterior cervical lymphadenopathy. History and physical examination are insufficient for the diagnosis. The Centor criteria or McIsaac score can help risk stratify patients for subsequent testing or treatment. Antibiotics may reduce symptom duration and suppurative complications, but the effect is small. Rheumatic fever is uncommon in developed countries, and shared decision making is recommended if antibiotics are used for this indication. Oral analgesics and topical anesthetics are important for symptom management. Physicians should consider alternate diagnoses that may mimic GABHS pharyngitis, which can include epiglottitis, infectious mononucleosis, Kawasaki disease, acute retroviral syndrome, Lemierre's syndrome, Ludwig's angina, peritonsillar abscess, retropharyngeal abscess, and viral pharyngitis. A focused history and physical examination can help differentiate these conditions. CONCLUSIONS GABHS may present similarly to other benign and potentially deadly diseases. Diagnosis and treatment of pharyngitis should be based on clinical evaluation. Consideration of pharyngitis mimics is important in the evaluation and management of ED patients.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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11
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Abstract
Infectious and inflammatory conditions of the head and neck may present with impaired airways. An understanding of the pathophysiology will allow for accurate diagnosis and prompt intervention. Preintervention discussion and planning by members of the airway team are crucial in developing a primary and backup plans for safely securing the airway.
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Affiliation(s)
- Gary Linkov
- Temple University Hospital, Philadelphia, PA 19140, USA
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head & Neck Surgery, Voice, Airway & Swallowing Center, Temple University School of Medicine, 3440 North Broad Street Kresge West 312, Philadelphia, PA 19140, USA.
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12
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Lee DR, Lee CH, Won YK, Suh DI, Roh EJ, Lee MH, Chung EH. Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea. KOREAN JOURNAL OF PEDIATRICS 2015; 58:380-5. [PMID: 26576182 PMCID: PMC4644766 DOI: 10.3345/kjp.2015.58.10.380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/10/2014] [Accepted: 11/07/2014] [Indexed: 11/27/2022]
Abstract
Purpose Croup is a common pediatric respiratory illness with symptoms of varying severity. Moreover, epiglottitis is a rare disease that can rapidly progress to life-threatening airway obstruction. Although the clinical course and treatments differ between croup and epiglottitis, they are difficult to differentiate on presentation. We aimed to compare the clinical characteristics of croup and epiglottitis in Emergency Department patients. Methods The 2012 National Emergency Department Information System database of 146 Korean Emergency Departments was used to investigate patients aged ≤18 years presenting with croup or epiglottitis. Results We analyzed 19,374 croup patients and 236 epiglottitis patients. The male:female sex ratios were 1.9:1 and 2.3:1 and mean ages were 2.2±2.0 and 5.6±5.8 years, respectively. The peak incidence of croup was observed in July and that of epiglottitis was observed in May. The hospitalization rate was lower in croup than in epiglottitis patients, and the proportion of patients treated in the intensive care unit was lower among croup patients. The 3 most common chief complaints in both croup and epiglottitis patients were cough, fever, and dyspnea. Epiglottitis patients experienced dyspnea, sore throat, and vomiting more often than croup patients (P<0.05). Conclusion Both groups had similar sex ratios, arrival times, 3 most common chief complaints, and 5 most common comorbidities. Epiglottitis patients had a lower incidence rate, higher mean age of onset, and higher hospitalization rate and experienced dyspnea, sore throat, and vomiting more often than croup patients. Our results may help in the differential diagnosis of croup and epiglottitis.
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Affiliation(s)
- Doo Ri Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyu Lee
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Youn Kyung Won
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Eui-Jung Roh
- Department of Pediatrics, Sun General Hospital, Daejeon, Korea
| | - Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Korea
| | - Eun Hee Chung
- Department of Pediatrics, National Medical Center, Seoul, Korea
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Fujiwara T, Okamoto H, Ohnishi Y, Fukuoka T, Ichimaru K. Diagnostic accuracy of lateral neck radiography in ruling out supraglottitis: a prospective observational study. Emerg Med J 2014; 32:348-52. [PMID: 25142034 DOI: 10.1136/emermed-2013-203340] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 03/28/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of lateral neck radiographs (LNR) for acute supraglottitis in adults. DESIGN A single centre prospective observational study. SETTING Emergency department at Kurashiki Central Hospital, Japan. PARTICIPANTS Adult patients who underwent LNR to detect supraglottitis. MAIN OUTCOME MEASURES Presence of supraglottitis, based on nasopharyngeal laryngoscopy or a follow-up telephone call, 7-30 days after the visit. RESULTS 140 patients had LNR during the study period. 35 patients were excluded from further analysis because of lack of consent. Of the 105 eligible patients, 21 patients (20%) were given the diagnosis of supraglottitis: 17 of 29 with a radiographic abnormality, and 4 of 76 patients without a radiographic abnormality. Three of the four cases where LNR was negative was grade 1, and all cases of grade 3 or higher had abnormal LNR. Sensitivity and specificity (95% CI) of LNR for supraglottitis were 81.0% (64.2 to 97.7) and 85.7% (78.2 to 93.2), respectively. The positive predictive value of LNR was 58.6% (40.7 to 76.5) and the negative predictive value was 94.7% (89.7 to 99.8). The positive likelihood ratio of LNR was 5.67 (3.27 to 9.82) and the negative likelihood ratio was 0.22 (0.10 to 0.51). CONCLUSIONS LNR showed only moderate sensitivity and specificity for supraglottitis and would miss some cases of supraglottitis if the pre-test probability is high. LNR was very sensitive for grade 3 or higher supraglottitis, but would miss milder cases. TRIAL REGISTRATION UMIN000011928.
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Affiliation(s)
- Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Ehime University, Toon City, Ehime, Japan
| | - Hiroshi Okamoto
- Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan
| | - Yasuhiro Ohnishi
- Department of Radiology, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan
| | - Toshio Fukuoka
- Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan
| | - Kazuyuki Ichimaru
- Department of Otolaryngology Head and Neck Surgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka, Japan
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Corticosteroidi. RIANIMAZIONE IN ETÀ PEDIATRICA 2012. [PMCID: PMC7119940 DOI: 10.1007/978-88-470-2059-7_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
I corticosteroidi sono ormoni secreti dalla porzione corticale del surrene in seguito a stimolazione ipofisaria mediata dall’ormone adrenocorticotropo (ACTH). Sapendo che la surrenale è l’organo per eccellenza che controlla l’omeostasi dell’organismo, si evince come gli effetti dei cortisonici siano importanti e numerosi. Essi influenzano il metabolismo glucidico, lipidico e proteico, il sistema immunitario, il bilancio idroelettrolitico, le funzioni del sistema cardiovascolare, del rene, del sistema nervoso e del tessuto muscolare. Inoltre rendono l’organismo capace di resistere a numerosi stimoli nocivi, ai cambiamenti ambientali e agli eventi stressanti. Il cortisolo rappresenta il glucocorticoide fisiologico, ma alcune modificazioni della sua struttura hanno portato alla sintesi di molte molecole, che possiedono effetti farmacologici e durata di azione diversificati rispetto al composto di base.
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15
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Capps EF, Kinsella JJ, Gupta M, Bhatki AM, Opatowsky MJ. Emergency Imaging Assessment of Acute, Nontraumatic Conditions of the Head and Neck. Radiographics 2010; 30:1335-52. [DOI: 10.1148/rg.305105040] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Abstract
Acute supraglottitis is a serious, potentially fatal infection in both adults and children. Haemophilus influenzae type b (Hib) is the most common cause in children, even in this era of the Hib vaccine. Most cases of acute supraglottitis in adults are thought to be caused by other bacterial organisms, viral or combined viral-bacterial infections, and noninfectious etiologies. Early visualization of the larynx is essential, as is establishment of a secure airway in selected cases. Most cases will respond to intravenous antibiotic therapy and will not require an artificial airway. Admission to an area of high-intensity nursing is essential. Daily laryngoscopy is necessary to monitor response to treatment. Although the incidence of acute supraglottitis in children has decreased, isolated cases will be encountered and demand high vigilance.
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Cheung CS, Man SY, Graham CA, Mak PS, Cheung PS, Chan BC, Rainer TH. Adult epiglottitis: 6 years experience in a university teaching hospital in Hong Kong. Eur J Emerg Med 2009; 16:221-6. [DOI: 10.1097/mej.0b013e328320ad2f] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Abstract
The clinical spectrum of infectious causes of upper airway obstruction has changed dramatically in the last few decades, especially after the introduction of vaccines against diphtheria and Haemophilus influenzae. Nevertheless, infectious causes of upper airway obstruction remain an important source of morbidity and potential mortality in the pediatric age group. Physicians caring for children need to be cognizant of the clinical presentation of this group of disorders because prompt recognition and early appropriate treatment are lifesaving. Epiglottitis, or supraglottitis as some authors prefer, is a potentially life-threatening bacterial infection of the epiglottis and surrounding tissues, including the aryepiglottic folds, the arytenoids, and the supraglottic larynx. Despite the virtual elimination of invasive H. influenzae type B infection, it is important for physicians caring for children to understand the management issues surrounding patients with supraglottitis to avoid disastrous outcomes. As illustrated in the following case, these children may not always present with classic features of supraglottitis.
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Abstract
Acute pharyngitis is one of the most common illnesses for which patients visit primary care physicians. Most cases are of viral origin, and with few exceptions these illnesses are both benign and self-limited. The most important bacterial cause is the beta-hemolytic group A streptococcus. There are other uncommon or rare types of pharyngitis. For some of these treatment is required or available, and some may be life threatening. Among those discussed in this article are diphtheria, gonorrhea, HIV infection, peritonsillar abscess, and epiglottitis.
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Affiliation(s)
- Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, 090-A Dominion Tower #812, Miami, FL 33136, USA
- Medical Service, Infectious Diseases Section (111-1), Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125, USA
| | - Alan L. Bisno
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, 090-A Dominion Tower #812, Miami, FL 33136, USA
- Medical Service (111), Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125, USA
- Corresponding author. Medical Service (111), Miami Veterans Affairs Healthcare System, 1201 NW 16th St., Miami, FL 33125.
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Willis KC. Bronchiolitis: Advanced Practice Focus in the Emergency Department. J Emerg Nurs 2007; 33:346-51. [PMID: 17643797 DOI: 10.1016/j.jen.2007.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kerry C Willis
- Lehigh Valley Hospital University MedEvac, Nurse Practitioner, Emergency Department, Lehigh Valley Hospital, Allentown, Penn, USA.
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Bayar Muluk N, Altan Kara S, Yazgan C. Evaluation of acute trismus by MRI: a case report. Bilateral peritonsillar cellulitis. Eur Arch Otorhinolaryngol 2006; 263:1139-41. [PMID: 16804718 DOI: 10.1007/s00405-006-0109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 06/01/2006] [Indexed: 10/24/2022]
Abstract
We describe a rare case of a bilateral peritonsillar cellulitis (PTC). The clinical presentation of fever, trismus and odynophagia was consistent with PTC, more evident on the right side; but the presence of bilateral tonsillar swelling and midline uvula confounded the diagnosis. In spite of the throat examination was performed with a great difficulty due to trismus, the T2 weighted fat saturated STIR magnetic resonance imaging (MRI) guided us to make the diagnosis and to start the intravenous antibiotic treatment immediately.
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Affiliation(s)
- Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kirikkale University, Kirikkale, Turkey.
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