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A systematic review and meta‐analysis of predictors of airway intervention in adult epiglottitis
Author(s) -
Sideris Anders,
Holmes Timothy R.,
Cumming Benjamin,
Havas Thomas
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28076
Subject(s) - medicine , epiglottitis , stridor , airway , incidence (geometry) , meta analysis , relative risk , haemophilus influenzae , population , systematic review , pediatrics , medline , surgery , confidence interval , physics , environmental health , biology , bacteria , law , political science , optics , genetics
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