Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
Clin Otolaryngol. 2013 Apr;38(2):142-7. doi: 10.1111/coa.12103.
To evaluate the predictive factor of epiglottic abscess and to investigate whether routine computerised tomography (CT) in patients with acute supraglottitis are necessary.
A prospective and multicentre study.
Tertiary care referral medical centre.
A total of 202 patients with suspected acute supraglottitis were enrolled. All patients underwent CT to confirm the presence of abscess.
The patients' characteristics, symptoms at presentation, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification and initial laboratory finding were analysed.
Of 202 patients, 158 (78%) had acute supraglottitis and 44 (22%) had epiglottic abscess. There was no significant difference in age between the acute supraglottitis group and the epiglottic abscess group. Men were significantly more frequent in the epiglottic abscess group than females (P = 0.042). When comparing the symptom at presentation, the patients with epiglottic abscess complained of voice change more frequently (P = 0.003). Moderate or severe epiglottic swelling in scope classification was significantly associated with epiglottic abscess (P < 0.001). In logistic regression analysis, voice change [OR = 2.64, 95% CI = 1.29-5.40, P = 0.008] and moderate or severe epiglottic swelling in laryngoscopic findings [OR = 3.94, 95% CI = 1.63-9.53, P = 0.002] were independent predictive factors for epiglottic abscess. The positive predictive values of voice change and moderate or severe epiglottic swelling were 33% and 30%, respectively. The negative predictive values of voice change and moderate or severe epiglottic swelling were 15% and 9%, respectively.
Routine CT might be suggested for diagnosis of epiglottic abscess in the patients with acute supraglottitis, because of the poor predictive values of symptoms and signs.
评估会厌脓肿的预测因素，并探讨急性会厌炎患者是否需要常规行计算机断层扫描（CT）检查。
前瞻性多中心研究。
三级转诊医疗中心。
共纳入 202 例疑似急性会厌炎患者。所有患者均行 CT 以明确是否存在脓肿。
分析患者的特征、就诊时的症状、喉镜下会厌肿胀和杓状软骨肿胀的内镜分类以及初始实验室检查结果。
202 例患者中，158 例（78%）为急性会厌炎，44 例（22%）为会厌脓肿。急性会厌炎组和会厌脓肿组患者的年龄无显著差异。会厌脓肿组男性显著多于女性（P=0.042）。比较就诊时的症状，会厌脓肿组患者更常出现声音改变（P=0.003）。内镜分类中中度或重度会厌肿胀与会厌脓肿显著相关（P<0.001）。Logistic 回归分析显示，声音改变[比值比（OR）=2.64，95%置信区间（CI）=1.29-5.40，P=0.008]和喉镜检查中中度或重度会厌肿胀（OR=3.94，95%CI=1.63-9.53，P=0.002）是会厌脓肿的独立预测因素。声音改变和中度或重度会厌肿胀的阳性预测值分别为 33%和 30%，阴性预测值分别为 15%和 9%。
鉴于症状和体征的预测价值较低，对于急性会厌炎患者，建议行常规 CT 检查以明确是否存在会厌脓肿。
