ADULT EPIGLOTTITIS IN A CANADIAN SETTING

The objective of this study was to determine stable estimates of the i ncidence, case fatality, and epidemiologic features of adult epiglotti tis, and risk factors for intubation. The authors designed? a retrospe ctive cohort combined with a nested case-control study, followed by de tailed analysis of cases from two tertiary care institutions, Among 81 3 cases, the incidence was 2.02 cases/10(5) population per year. Ten r ecorded deaths constituted a case fatality rate off 1.2%, (95% confide nce interval [CI]: 0.5%; to 1.9%). The eight fully documented deaths i ndicated no sudden episodes of catastrophic upper airway obstructions without previous dyspnea. A detailed review of 51 cases revealed that 18% of patients underwent expeditious intubation. Patients managed ppi ;without initially requiring intubation did not need emergency airway interventions. Only the presence of dyspnea (noted in 29% of patients) at the time of admission (P < 0.001) predicted the need for intubatio n. A low case fatality rate in a conservatively managed cohort and the absence of sudden upper airway catastrophes in patients without dyspn ea suggest that prophylactic intubation sand intensive care unit monit oring ; is not warranted in all patients. An early complaint of dyspne a may safely discriminate between patients requiring invasive airway m anagement and close observation.