Association of Early Steroid and Antibiotic Therapy With Airway Outcomes in Adult Epiglottitis: A 10-Year Multicenter Retrospective Cohort Study.

BACKGROUND

Adult epiglottitis is an uncommon but potentially life-threatening condition requiring rapid recognition and airway-focused management, yet evidence regarding early medical therapy is limited. We evaluated temporal trends in adult epiglottitis and examined associations between early corticosteroid or antibiotic therapy and clinically important outcomes.

METHODS

We conducted a retrospective cohort study of adults (≥ 18 years) presenting to U.S. emergency departments with acute epiglottitis between 2014 and 2024 using the TriNetX Research Network. Cases were identified using the ICD-10 code J05.1; patients with preexisting tracheostomy were excluded. Early therapy was defined as systemic corticosteroid or parenteral antibiotic administration within 24 h of presentation. The primary outcome was endotracheal intubation; secondary outcomes included ICU admission, 30-day ED recidivism, and 30-day mortality. Propensity score matching (1:1) and multivariable Cox proportional hazards models were used to estimate risk ratios (RRs) and hazard ratios (HRs).

RESULTS

The annual incidence proportion of adult epiglottitis increased from 0.002% in 2014 to 0.005% in 2024 (RR per year 1.09; 95% CI 1.08-1.10), with the steepest rise among adults aged 60-74 years. In matched cohorts, early corticosteroid therapy was associated with lower risks of intubation (RR 0.48; 95% CI 0.26-0.88) and ICU admission (RR 0.71; 95% CI 0.55-0.92). Early antibiotic therapy demonstrated similar associations for intubation (RR 0.54; 95% CI 0.34-0.85) and ICU admission (RR 0.72; 95% CI 0.60-0.86). In adjusted Cox models, early steroids (HR 0.33; 95% CI 0.25-0.44) and early antibiotics (HR 0.50; 95% CI 0.34-0.75) were independently associated with lower hazards of intubation. Older age, comorbidities, and hypoxia were strong predictors of airway compromise.

CONCLUSIONS

Adult epiglottitis incidence has increased over the past decade, particularly among older adults. Early corticosteroid and antibiotic therapy were independently associated with lower risks of intubation and ICU admission, supporting current clinical practice favoring timely medical therapy in adults with suspected epiglottitis.