Don't Rush to Intervene in Pediatric Epiglottitis

WASHINGTON – Managing pediatric epiglottitis without intervention resulted in significantly shortened hospital stays and lower costs, based on data from 820 children.

"Due to the increasing rarity of this disease, suspicion for the diagnosis must remain high for prompt recognition and treatment," said Dr. Marci J. Neidich of Cincinnati Children’s Hospital Medical Center. The use of intubation and tracheotomy to treat epiglottitis in children continues to decline, with a trend toward conservative management, she noted at the annual meeting of the American Academy of Otolaryngology – Head and Neck Surgery Foundation.

To assess the predictive factors for intervention, Dr. Neidich and her colleagues reviewed data from 820 patients in the Kids’ Inpatient Databases for 2006 and 2009 who were treated for acute epiglottitis with and without obstruction.

Overall, 705 children (86%) were managed conservatively and 115 (14%) required intervention (defined as either a tracheotomy or intubation).

Conservative management of epiglottitis in children resulted in a significantly shorter length of hospital stay compared with intervention (an average of 4 days vs. 11 days). The average cost was significantly lower as well ($18,487 vs. $83,037).

Patients were significantly more likely to be managed conservatively in urgent admission compared with emergent cases, and in urban nonteaching hospitals compared with urban teaching hospitals.

Other significant predictors of conservative management included being in a hospital not primarily for children versus a children’s unit or children’s hospital, and being in a small or medium-sized hospital compared with a large hospital.

There were no significant differences in age, race, or sex between the nonintervention and intervention groups. Approximately one-third were female, and approximately 42% were white. The average age was 6 years in the intervention group and 8 years in the nonintervention group. Mortality was less than 10 patients.

The results suggest that most children with epiglottitis can be managed conservatively for a lower cost and with shorter hospital stays and lower mortality rates, said Dr. Neidich. However, additional studies are needed to investigate which patients would be appropriate for intervention versus conservative management, she said.

Dr. Neidich reported having no relevant financial conflicts.

WASHINGTON – Managing pediatric epiglottitis without intervention resulted in significantly shortened hospital stays and lower costs, based on data from 820 children.

"Due to the increasing rarity of this disease, suspicion for the diagnosis must remain high for prompt recognition and treatment," said Dr. Marci J. Neidich of Cincinnati Children’s Hospital Medical Center. The use of intubation and tracheotomy to treat epiglottitis in children continues to decline, with a trend toward conservative management, she noted at the annual meeting of the American Academy of Otolaryngology – Head and Neck Surgery Foundation.

To assess the predictive factors for intervention, Dr. Neidich and her colleagues reviewed data from 820 patients in the Kids’ Inpatient Databases for 2006 and 2009 who were treated for acute epiglottitis with and without obstruction.

Overall, 705 children (86%) were managed conservatively and 115 (14%) required intervention (defined as either a tracheotomy or intubation).

Conservative management of epiglottitis in children resulted in a significantly shorter length of hospital stay compared with intervention (an average of 4 days vs. 11 days). The average cost was significantly lower as well ($18,487 vs. $83,037).

Patients were significantly more likely to be managed conservatively in urgent admission compared with emergent cases, and in urban nonteaching hospitals compared with urban teaching hospitals.

Other significant predictors of conservative management included being in a hospital not primarily for children versus a children’s unit or children’s hospital, and being in a small or medium-sized hospital compared with a large hospital.

There were no significant differences in age, race, or sex between the nonintervention and intervention groups. Approximately one-third were female, and approximately 42% were white. The average age was 6 years in the intervention group and 8 years in the nonintervention group. Mortality was less than 10 patients.

The results suggest that most children with epiglottitis can be managed conservatively for a lower cost and with shorter hospital stays and lower mortality rates, said Dr. Neidich. However, additional studies are needed to investigate which patients would be appropriate for intervention versus conservative management, she said.

Dr. Neidich reported having no relevant financial conflicts.

WASHINGTON – Managing pediatric epiglottitis without intervention resulted in significantly shortened hospital stays and lower costs, based on data from 820 children.

"Due to the increasing rarity of this disease, suspicion for the diagnosis must remain high for prompt recognition and treatment," said Dr. Marci J. Neidich of Cincinnati Children’s Hospital Medical Center. The use of intubation and tracheotomy to treat epiglottitis in children continues to decline, with a trend toward conservative management, she noted at the annual meeting of the American Academy of Otolaryngology – Head and Neck Surgery Foundation.

To assess the predictive factors for intervention, Dr. Neidich and her colleagues reviewed data from 820 patients in the Kids’ Inpatient Databases for 2006 and 2009 who were treated for acute epiglottitis with and without obstruction.

Overall, 705 children (86%) were managed conservatively and 115 (14%) required intervention (defined as either a tracheotomy or intubation).

Conservative management of epiglottitis in children resulted in a significantly shorter length of hospital stay compared with intervention (an average of 4 days vs. 11 days). The average cost was significantly lower as well ($18,487 vs. $83,037).

Patients were significantly more likely to be managed conservatively in urgent admission compared with emergent cases, and in urban nonteaching hospitals compared with urban teaching hospitals.

Other significant predictors of conservative management included being in a hospital not primarily for children versus a children’s unit or children’s hospital, and being in a small or medium-sized hospital compared with a large hospital.

There were no significant differences in age, race, or sex between the nonintervention and intervention groups. Approximately one-third were female, and approximately 42% were white. The average age was 6 years in the intervention group and 8 years in the nonintervention group. Mortality was less than 10 patients.

The results suggest that most children with epiglottitis can be managed conservatively for a lower cost and with shorter hospital stays and lower mortality rates, said Dr. Neidich. However, additional studies are needed to investigate which patients would be appropriate for intervention versus conservative management, she said.

Dr. Neidich reported having no relevant financial conflicts.