New Algorithm for Supraglottitis Staging in Adults

Abstract

Objectives: (1) Critically review the current staging systems of supraglottitis in adults. (2) Suggest a new algorithm for infections involving the supraglottis based on clinical staging considering anatomical subsites and outcome correlation. Methods: We retrospectively identified adult patients with acute supraglottitis during the years of 1990 through 2013 by using International Classification of Disease codes. Patients were graded by using 2 systems: the Scope grading system for epiglottitis, and our new suggested grading system, which relies on the edema in 3 subsites: the epiglottis, the aryepiglottic folds and arytenoids, and the larynx. Those subsites were given the following grades: 0 = no edema, 1 = mild edema, 2 = moderate edema, and 3 = severe edema. Summation of the 3 subsites scores was performed in order to assess the need for airway intervention. Results: A total of 288 eligible patients were enrolled. Diagnosis was made by either indirect or fiberoptic laryngoscopy (or by both modalities). One hundred seventy-eight patients (62%) had Scope grades of 0 or 1, and 110 patients (38%) had Scope grades of 2 or 3. Of these, 24% required an airway intervention. According to our classification, 236 patients (82%) who had a score of ≤4 were less likely to undergo a securing airway intervention, when compared with the 52 patients (18%) who had a score of ≥5, 4% vs 33%, respectively ( P = .03). All patients graded with ≥8 score required airway intervention. Conclusions: Our new suggested flow chart of decisions is based on an easy grading system, which allows dynamic description of patient progression during sequential examinations, easy information transmission, and decision making.