ACUTE EPIGLOTTITIS - AN 18-YEAR EXPERIENCE IN RHODE-ISLAND

Objective: To assess the incidence, clinical characteristics, manageme nt, and outcome of epiglottitis in a defined population over an 18-yea r period. Design: Case series. Setting: The state of Rhode Island, 197 5 through 1992. Patients or other participants: Cases who met predeter mined criteria for acute epiglottitis identified from hospital dischar ges and the State Medical Examiner's log of prehospitalization deaths. Main outcome measures: Incidence by year and age, clinical presentati on, results of diagnostic evaluations, management, and outcome. Result s: Four hundred seven cases were identified, 134 in children and 273 i n adults, Incidence in children dropped from 38 cases in the first 3 y ears of the study to 1 case in the last 3 years (p<0.001). Adult cases increased from 17 in the first 3 years to 69 in the last 3 years (p<0 .001). Seventy-nine percent of adults and 32% of children were treated without an artificial airway, Factors associated with airway obstruct ion included symptomatic respiratory difficulty, strider, drooling, sh orter duration of symptoms, enlarged epiglottis on radiograph, and Hae mophilus influenzae bacteremia (p<0.001 for each), Twelve patients die d (3 children and 9 adults), with all cases of fatal respiratory obstr uction occurring within 12 h of presentation.