Vaid Prince, Farrell Eric, Donnelly Martin
ENT Dept. University Hospital Waterford, Ireland.
ENT Dept. University Hospital Waterford, Ireland.
Am J Otolaryngol. 2021 Nov-Dec;42(6):103084. doi: 10.1016/j.amjoto.2021.103084. Epub 2021 May 19.
Acute supraglottitis (AS) can be a life threatening infection that may lead to sudden airway obstruction. Thankfully, paediatric instances have decreased with public health vaccination programmes. Owing to the nature of the location of pathology, this time sensitive emergency requires astute clinical acumen and awareness of early warning signs. This study aimed to i) determine if the incidence of AS has changed over time; ii) investigate geographical and seasonal variation of infection; iii) identify features of presentation which may predict airway intervention; iv) assess efficacy of treatment and make recommendations for management.
All adult patients admitted to a tertiary hospital with the diagnosis of acute supraglottitis between 2013 and 2021 were included. Diagnosis was confirmed with flexible nasendoscopy and consultant review. Demographics, management and outcomes were recorded. Statistical analysis was performed by calculating means and standard deviation for descriptive purposes. Fischer's exact test and two tailed t-test for categorical and continuous variables respectively. Results were deemed significant if P values of less than or equal to 0.05 were calculated.
Forty-three adults were identified. Five patients (11.6%) required airway intervention. Stridor, respiratory distress and CRP of >100 mg/L were noted to be significant predictive factors for airway intervention. Intubated patients had a significantly longer hospital stay. Regions with a higher population density were noted to have a higher incidence but this did not prove to be significant.
This is the largest study of AS in Ireland to date. There is a trend towards increasing incidence of acute supraglottitis in adults. Factors such as stridor, respiratory distress and elevated CRP should alert the clinician to the possible need for airway intervention. Acute supraglottitis is more common in higher density populated regions.
急性会厌炎（AS）是一种可能危及生命的感染，可导致气道突然阻塞。幸运的是，随着公共卫生疫苗接种计划的实施，儿科病例有所减少。由于病变位置的性质，这种时间敏感的紧急情况需要敏锐的临床洞察力和对早期预警信号的认识。本研究旨在：i）确定AS的发病率是否随时间变化；ii）调查感染的地理和季节差异；iii）识别可能预测气道干预的临床表现特征；iv）评估治疗效果并提出管理建议。
纳入2013年至2021年期间在一家三级医院确诊为急性会厌炎的所有成年患者。通过软性鼻内镜检查和会诊确诊。记录人口统计学、治疗和结果。进行统计分析以计算均值和标准差用于描述性目的。分别对分类变量和连续变量进行费舍尔精确检验和双尾t检验。如果计算出的P值小于或等于0.05，则结果被认为具有统计学意义。
共确定了43名成年人。5名患者（11.6%）需要气道干预。喘鸣、呼吸窘迫和CRP>100mg/L被认为是气道干预的重要预测因素。插管患者的住院时间明显更长。人口密度较高的地区发病率较高，但未证明具有统计学意义。
这是迄今为止爱尔兰关于AS的最大规模研究。成人急性会厌炎的发病率有上升趋势。喘鸣、呼吸窘迫和CRP升高应提醒临床医生可能需要进行气道干预。急性会厌炎在人口密度较高的地区更为常见。
