Laryngology
A systematic review and meta‐analysis of predictors of airway intervention in adult epiglottitis
Anders Sideris MBBS, BMedSci (Hons) Timothy R. Holmes MBBS Benjamin Cumming MBBS Thomas Havas MBBS, MD, FRACS (ORL H&N), FRCSE (ORL H&N), FACS
First published: 07 June 2019 https://doi.org/10.1002/lary.28076
Editor's Note: This Manuscript was accepted for publication on May 1, 2019.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objective
Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease.
Methods
The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random‐effects model meta‐analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention.
Results
Thirty studies and a total of 10,148 patients were finally included for meta‐analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention.
Conclusion
In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention.
Laryngoscope, 2019
A systematic review and meta‐analysis of predictors of airway intervention in adult epiglottitis
Anders Sideris MBBS, BMedSci (Hons) Timothy R. Holmes MBBS Benjamin Cumming MBBS Thomas Havas MBBS, MD, FRACS (ORL H&N), FRCSE (ORL H&N), FACS
First published: 07 June 2019 https://doi.org/10.1002/lary.28076
Editor's Note: This Manuscript was accepted for publication on May 1, 2019.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Read the full text
ePDFPDFTOOLS SHARE
Abstract
Objective
Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease.
Methods
The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random‐effects model meta‐analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention.
Results
Thirty studies and a total of 10,148 patients were finally included for meta‐analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention.
Conclusion
In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention.
Laryngoscope, 2019
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