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Sideris A, Holmes TR, Cumming B, Havas T. A systematic review and meta-analysis of predictors of airway intervention in adult epiglottitis. Laryngoscope 2019; 130:465-473. [PMID: 31173373 DOI: 10.1002/lary.28076] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease. METHODS The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random-effects model meta-analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention. RESULTS Thirty studies and a total of 10,148 patients were finally included for meta-analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention. CONCLUSION In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention. LEVEL OF EVIDENCE NA Laryngoscope, 130:465-473, 2020.
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Affiliation(s)
- Anders Sideris
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Timothy R Holmes
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Benjamin Cumming
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Thomas Havas
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
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Chau CW, Chan HH, Wong CP, Wong TW, Lau CC. Sonographic Measurement of the Epiglottis in Normal Chinese Adults. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives (1) To assess the normal range of thickness of the epiglottis by means of ultrasound measurement. (2) To evaluate inter-observer agreement in measuring the thickness of the epiglottis of normal individuals by ultrasound. (3) To assess the association between biological factors and the thickness of the epiglottis. Methods Fifty adult volunteers working at a local accident and emergency department were recruited. The thickness of the epiglottis was measured by means of ultrasound examination, which was performed twice by two emergency physicians at different time. The study subjects' age, sex, height and body weight were recorded. Results The mean thickness of the epiglottis was 0.236 cm and the standard deviation was 0.020. Male subjects had thicker epiglottis. Interobserver agreement of the two emergency physicians who performed the ultrasound scan was very good. Multiple regression models showed that sex and height were useful predictors of the thickness of the epiglottis. Conclusions Bedside ultrasound assessment of the epiglottis is an easy, rapid and reliable method to evaluate its thickness. Further studies are needed to evaluate the thickness of the epiglottis in patients with epiglottitis before it can be put into clinical use.
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