ORIGINAL CONTRIBUTION epiglottitis
Epiglottitis: Comparison of Signs and Symptoms in Children Less Than 2 Years Old and Older A 20-year retrospective review of 236 children with epiglottitis was performed to determine the frequency of occurrence of 21 presenting signs and symptoms. To determine the association of age with clinical presentation and diagnosis of epiglottitis, the signs and symptoms of children less than 2 years old were compared with those of children 2 years of age and older. Fifty-eight children (25%) were less than 2 years old. Sore throat was the only factor significantly different in the two age groups (P < .01), occurring more commonly in the older children. There were 128 children (54%) with blood cultures positive for Haemophilus influenzae. Analyses of patients with positive blood cultures gave similar results. The signs and symptoms that clinically support epiglottitis in children less than 2 years old are similar in older children. [Losek JD, D e w i t z - Z i n k BA, MelzerLange M, Havens PL: Epiglottitis: Comparison of signs and symptoms in children less than 2 years old and older. Ann Emerg Med January 1990; 19:55-58.] INTRODUCTION Signs and symptoms of epiglottitis include acute onset of fever, sore throat, dysphagia, drooling, muffled voice, preference for upright position, and difficulty breathing, l-3 Although this life-threatening infectious disorder commonly occurs in children 3 to 7 years old, it also occurs in infants and adults. 4-9 Recent reports suggest that the manifestations of epiglottitis in children less than 2 years old are different than in children more than 2 years old. le-l~ This review was conducted to determine the clinical characteristics of children with epiglottitis admitted to Children's Hospital of Wisconsin and to compare the signs and symptoms of children less than 2 years old with those of children 2 years of age and older.
Joseph D Losek, MD Barbara A Dewitz-Zink, MD Marlene Melzer-Lange, MD Peter L Havens, MD Milwaukee, Wisconsin From the Department of Pediatrics, Medical College of Wisconsin, Children's Hospital, Milwaukee, Wisconsin. Received for publication April 11, 1989. Revision received July 24, 1989. Accepted for publication September 12, 1989. Address for reprints: Joseph D Losek, MD, Department of Pediatrics, Children's Hospital of Wisconsin, PQ Box 1997, MS #756, Milwaukee, Wisconsin 53201.
METHODS We retrospectively reviewed the medical records of children admitted to Children's Hospital of Wisconsin from January 1968 through December 1987 with the discharge diagnosis of epiglottitis. Patients with a red and enlarged epiglottis on direct visualization or an enlarged epiglottis on roentgenography were included. Patient characteristics recorded from the emergency department or initial history and physical records were age; gender; history of fever, irritability, refusal to eat or drink, drooling, not sleeping, change in voice or cry, stridor, difficulty breathing, preference for sitting, cough, coryza, sore throat, or vomiting; and time from onset of symptoms to hospital presentation. Initial temperature (fever defined as temperature of 38 C or higher) and presence of retractions, stridor, drooling, preference for sitting, pallor, cyanosis, or hypotonia were recorded. Laboratory data included results of blood culture, complete blood count, and lateral neck and chest roentgenograms. Finally, treatment, complications, final diagnosis, and outcome were recorded. If the presence or absence of one of these characteristics was not documented in the records, it was recorded as unknown. Differences in prevalence of specific clinical characteristics were analyzed by patient age {less than 2 years or 2 years or older). Significance of the differences was assessed by x 2 or Wilcoxon rank-sum tests. Because multiple comparisons were made, P
Epiglottitis: Comparison of Signs and Symptoms in Children Less Than 2 Years Old and Older A 20-year retrospective review of 236 children with epiglottitis was performed to determine the frequency of occurrence of 21 presenting signs and symptoms. To determine the association of age with clinical presentation and diagnosis of epiglottitis, the signs and symptoms of children less than 2 years old were compared with those of children 2 years of age and older. Fifty-eight children (25%) were less than 2 years old. Sore throat was the only factor significantly different in the two age groups (P < .01), occurring more commonly in the older children. There were 128 children (54%) with blood cultures positive for Haemophilus influenzae. Analyses of patients with positive blood cultures gave similar results. The signs and symptoms that clinically support epiglottitis in children less than 2 years old are similar in older children. [Losek JD, D e w i t z - Z i n k BA, MelzerLange M, Havens PL: Epiglottitis: Comparison of signs and symptoms in children less than 2 years old and older. Ann Emerg Med January 1990; 19:55-58.] INTRODUCTION Signs and symptoms of epiglottitis include acute onset of fever, sore throat, dysphagia, drooling, muffled voice, preference for upright position, and difficulty breathing, l-3 Although this life-threatening infectious disorder commonly occurs in children 3 to 7 years old, it also occurs in infants and adults. 4-9 Recent reports suggest that the manifestations of epiglottitis in children less than 2 years old are different than in children more than 2 years old. le-l~ This review was conducted to determine the clinical characteristics of children with epiglottitis admitted to Children's Hospital of Wisconsin and to compare the signs and symptoms of children less than 2 years old with those of children 2 years of age and older.
Joseph D Losek, MD Barbara A Dewitz-Zink, MD Marlene Melzer-Lange, MD Peter L Havens, MD Milwaukee, Wisconsin From the Department of Pediatrics, Medical College of Wisconsin, Children's Hospital, Milwaukee, Wisconsin. Received for publication April 11, 1989. Revision received July 24, 1989. Accepted for publication September 12, 1989. Address for reprints: Joseph D Losek, MD, Department of Pediatrics, Children's Hospital of Wisconsin, PQ Box 1997, MS #756, Milwaukee, Wisconsin 53201.
METHODS We retrospectively reviewed the medical records of children admitted to Children's Hospital of Wisconsin from January 1968 through December 1987 with the discharge diagnosis of epiglottitis. Patients with a red and enlarged epiglottis on direct visualization or an enlarged epiglottis on roentgenography were included. Patient characteristics recorded from the emergency department or initial history and physical records were age; gender; history of fever, irritability, refusal to eat or drink, drooling, not sleeping, change in voice or cry, stridor, difficulty breathing, preference for sitting, cough, coryza, sore throat, or vomiting; and time from onset of symptoms to hospital presentation. Initial temperature (fever defined as temperature of 38 C or higher) and presence of retractions, stridor, drooling, preference for sitting, pallor, cyanosis, or hypotonia were recorded. Laboratory data included results of blood culture, complete blood count, and lateral neck and chest roentgenograms. Finally, treatment, complications, final diagnosis, and outcome were recorded. If the presence or absence of one of these characteristics was not documented in the records, it was recorded as unknown. Differences in prevalence of specific clinical characteristics were analyzed by patient age {less than 2 years or 2 years or older). Significance of the differences was assessed by x 2 or Wilcoxon rank-sum tests. Because multiple comparisons were made, P
