Cureus · 2024
Predictors of Emergency Interventions in Acute Airway Obstructive Diseases: A Retrospective Single-Center Observational Study.
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Suzuki Naoya, Doi Tomoki, Abe Takeru, Michishita Takahiro, Gakumazawa Masayasu, Takeuchi Ichiro
Аннотация
BACKGROUND: The factors related to emergency intervention for internal medicine conditions leading to airway obstruction are not clear.
OBJECTIVE: We aimed to identify factors associated with emergency interventions in acute airway obstructive diseases (AAODs).
METHODS: This is a retrospective observational single-center study. We defined AAODs as acute epiglottitis, peritonsillar abscess, tonsillitis, pharyngitis, oral floor abscess, neck abscess, angioedema, Lemierre's syndrome, hemoptysis, and airway foreign body. We compared the group required airway interventions (intubation, cricothyroidotomy, tracheostomy) with the group treated conservatively admitted to Yokosuka Kyosai Hospital, Japan (tertiary referral hospital) for AAOD between April 2012 and March 2022.
RESULTS: Two hundred fifty-five patients were admitted for AAOD, 104 patients were excluded, and 150 patients (39 intervention group, 111 conservative group) were analyzed. Univariate analysis revealed significant age differences (74(61-78) vs 67(31-76), p<0.01), Glasgow Coma Scale (15(14-15) vs 15(15-15), p<0.01), respiratory rate (24(20-30) vs 20(16-22), p<0.01), National Early Warning Score (NEWS) (6(3-9) vs 3(1-5), p<0.01), Sequential Organ Failure Assessment (SOFA) score (2(1-4) vs 0(0-2), p<0.01), stridor (26% vs 2%, p<0.01), dysphagia (41% vs 21%, p=0.02), drooling (18% vs 3%, p<0.01), frequent suctions (6% vs 0%, p<0.01), airway examination abnormalities (AEAs) (69% vs 32%, p<0.01) and diagnosis (p<0.01). Multivariate logistic regression analysis indicated AEA (OR=9.41, 95%CI 3.66-24.2), upper airway diseases (OR=5.74, 95%CI 2.12-15.6), and SOFA score (OR=2.88, 95%CI 1.06-7.83) were predictors for intervention. However, the sensitivity and specificity of AEA were 0.69 (95%CI 0.52-0.83) and 0.69 (95%CI 0.59-0.77), respectively.
CONCLUSIONS: AEAs were associated with a high risk of airway interventions in AAOD. Nevertheless, the sensitivity and specificity were insufficient.
OBJECTIVE: We aimed to identify factors associated with emergency interventions in acute airway obstructive diseases (AAODs).
METHODS: This is a retrospective observational single-center study. We defined AAODs as acute epiglottitis, peritonsillar abscess, tonsillitis, pharyngitis, oral floor abscess, neck abscess, angioedema, Lemierre's syndrome, hemoptysis, and airway foreign body. We compared the group required airway interventions (intubation, cricothyroidotomy, tracheostomy) with the group treated conservatively admitted to Yokosuka Kyosai Hospital, Japan (tertiary referral hospital) for AAOD between April 2012 and March 2022.
RESULTS: Two hundred fifty-five patients were admitted for AAOD, 104 patients were excluded, and 150 patients (39 intervention group, 111 conservative group) were analyzed. Univariate analysis revealed significant age differences (74(61-78) vs 67(31-76), p<0.01), Glasgow Coma Scale (15(14-15) vs 15(15-15), p<0.01), respiratory rate (24(20-30) vs 20(16-22), p<0.01), National Early Warning Score (NEWS) (6(3-9) vs 3(1-5), p<0.01), Sequential Organ Failure Assessment (SOFA) score (2(1-4) vs 0(0-2), p<0.01), stridor (26% vs 2%, p<0.01), dysphagia (41% vs 21%, p=0.02), drooling (18% vs 3%, p<0.01), frequent suctions (6% vs 0%, p<0.01), airway examination abnormalities (AEAs) (69% vs 32%, p<0.01) and diagnosis (p<0.01). Multivariate logistic regression analysis indicated AEA (OR=9.41, 95%CI 3.66-24.2), upper airway diseases (OR=5.74, 95%CI 2.12-15.6), and SOFA score (OR=2.88, 95%CI 1.06-7.83) were predictors for intervention. However, the sensitivity and specificity of AEA were 0.69 (95%CI 0.52-0.83) and 0.69 (95%CI 0.59-0.77), respectively.
CONCLUSIONS: AEAs were associated with a high risk of airway interventions in AAOD. Nevertheless, the sensitivity and specificity were insufficient.