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.