Do we need a change in ED diagnostic strategy for adult acute epiglottitis?

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Do we need a change in ED diagnostic strategy for adult acute epiglottitis?

Am J Emerg Med. 2017 Oct;35(10):1519-1524

Authors: Lee SH, Yun SJ, Kim DH, Jo HH, Ryu S

Abstract
OBJECTIVES: To retrospectively evaluate the diagnostic performance of qualitative and quantitative radiographic parameters for diagnosing adult acute epiglottitis, and identify the prevalence and risk factors of false-negative neck radiography-based diagnosis of acute epiglottitis.
METHODS: An emergency physician and a radiologist independently reviewed neck radiographs of 91 patients with laryngoscopy-confirmed acute epiglottitis and 91 control subjects between March 2010 and June 2016 for qualitative and quantitative radiographic parameters of acute epiglottitis, and concluded a diagnosis. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of radiographic parameters, while independent risk factors of false-negative diagnosis were determined by multivariate logistic regression analysis. Inter-observer agreement was also calculated.
RESULTS: All radiographic parameters showed good diagnostic performance with sensitivities and specificities of 33.0-80.2% and 64.8-100%, respectively. Epiglottis width (EW)>6.3mm showed the highest diagnostic performance (area under the ROC curve [AUC]: 0.867, sensitivity: 75.8%, specificity: 97.8%). Interobserver agreement for all radiographic parameters was excellent (range: 0.893-0.991). The lateral neck radiography-based false-negative diagnosis rate was 31.9%, and previous oral antibiotic usage was an independent risk factor of false-negative results.
CONCLUSION: EW>6.3mm showed the best diagnostic accuracy, facilitating a neck radiograph-based diagnosis of acute epiglottitis. However, false-negative results on neck radiograph are quite common and previous oral antibiotic usage is a risk factor. Based on the knowledge of the usefulness and risk factors of false-negative results of neck radiography, diagnostic process for acute epiglottitis using neck radiography need to be changed.

PMID: 28460811 [PubMed - indexed for MEDLINE]

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