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Review of epiglottitis in the post Haemophilus influenzae type‐b vaccine era
Author(s) -
Baird Samantha M.,
Marsh Philip A.,
Padiglione Alex,
Trubiano Jason,
Lyons Bernard,
Hays Andrew,
Campbell Matthew C.,
Phillips Damien
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14787
Subject(s) - medicine , epiglottitis , odynophagia , stridor , sore throat , dysphagia , laryngomalacia , pediatrics , airway , intensive care unit , intensive care medicine , surgery
Background This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type‐b vaccine introduction in Australia. Methods Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed. Results Eighty‐seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention ( P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type‐b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury. Conclusion Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection.