Adult acute supraglottitis: Analysis of 358 patients for predictors of airway intervention.

OBJECTIVES/HYPOTHESIS: Acute supraglottitis is a potentially life-threatening condition due to rapid onset upper airway obstruction. The study aimed to characterize adult acute supraglottitis patients and to recognize factors associated with an aggressive disease course.

STUDY DESIGN

Retrospective chart review.

METHODS

All adult acute supraglottitis patients admitted to a single academic medical center between 2000 and 2014 were included and their medical charts reviewed. The main outcome measures were airway intervention and mortality.

RESULTS

Three hundred fifty-eight patients were enrolled. Mean age was 53 years (range, 16-92 years), with 62.8% males. Sore throat (79%) and dysphagia (70.9%) were the most common symptoms. Stridor (3.6%), tachypnea (5.7%), and dyspnea (6.4%) were uncommon but significantly associated with airway intervention. The epiglottis was most commonly involved (67%). Involvement of the epiglottis and aryepiglottic folds showed a trend of correlation to airway intervention. Blood glucose levels, C-reactive protein (CRP) levels, and relative neutrophilia were significantly higher in patients admitted to the intensive care unit or requiring airway intervention. Thirty-four patients (9.5%) required intensive care unit admission. Sixteen patients (4.4%) required airway intervention. Recurrent episodes of supraglottitis, seen in 19 patients, were more common in males (P = .048), and tended to have a more severe clinical course, requiring more airway interventions (P = .005) and intensive care unit admissions (P = .016).

CONCLUSIONS

The typical high risk patient-a male, with dyspnea and stridor, presenting with edema of the epiglottis and aryepiglottic folds, elevated CRP, hyperglycemia, and a history of recurrent episodes-should warrant more aggressive treatment and closer observation.

LEVEL OF EVIDENCE

4 Laryngoscope, 127:2106-2112, 2017.