Pediatric Epiglottitis: Predictors of Conservative Treatment

Objective 1) To evaluate predictors of conservative management in pediatric patients with epiglottitis. 2) To use national trends, variances, and outcomes to better understand current management trends of this rare though highly morbid disease. Method The Kids’ Inpatient Databases (2006 and 2009) were searched using ICD‐9 CM codes for acute epiglottitis with (464.30) and without (464.31) obstruction. Demographics and hospital characteristics of pediatric patients who required airway intervention (defined as intubation or tracheotomy) were compared with those who were managed conservatively without airway intervention. Results A total of 820 patients were included in the analysis, and 115 (14%) required intervention and 86% were managed conservatively. Mortality was less than 10 patients. There were no significant differences between groups with respect to age, gender, or race. Characteristics predictive of conservative management include urgent admission type (vs emergent, P =. 015), urban nonteaching hospital (vs urban teaching, P =. 002), nonchildren’s hospital (vs children’s unit or children’s hospital, P <. 0001) and small/medium‐sized hospital (vs large, P =. 03). Length of hospital stay was shorter (mean 3.65 days vs 10.87 days, P =. 01) and cost was lower in patients who were managed conservatively (mean $18,487 vs $83,037, P <. 0001). Conclusion The majority of pediatric epiglottitis patients are currently managed without intubation or tracheotomy with low mortality. Conservatively managed admissions are more likely for nonemergent presentations at nonpediatric, nonteaching, small/medium‐sized hospitals, and are lower in cost. Additional studies are needed to further characterize patients which would be appropriate for conservative management.