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Title: Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era.
Austin Authors: Baird, Samantha M;Marsh, Philip A;Padiglione, Alex;Trubiano, Jason A ;Lyons, Bernard;Hays, Andrew;Campbell, Matthew C ;Phillips, Damien
Affiliation: Department of Otolaryngology, Royal Children's Hospital, Melbourne, Victoria, Australia
Department of Otolaryngology, Head and Neck and Skull Base Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
Ear Nose and Throat Unit, Monash Health, Melbourne, Victoria, Australia
Department of Ear Nose and Throat/Head and Neck Surgery, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Infectious Diseases Department, Monash Health, Melbourne, Victoria, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 2018 2018-09-11
Publication information: ANZ Journal of Surgery 2019; 92(2): e96-e107
Abstract: This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia. 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. 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. 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.
DOI: 10.1111/ans.14787
ORCID: 0000-0002-5274-8761
PubMed URL: 30207030
Type: Journal Article
Subjects: Haemophilus influenzae type-b
airway management
Appears in Collections:Journal articles

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