Acute epiglottitis in children: a conservative approach to diagnosis and management.

We report a series of 60 children with epiglottitis, 42 who were admitted via our emergency room and 18 who were transferred to Children's Hospital of Michigan (CHM) after initial airway management elsewhere. Patients managed entirely at CHM had lateral neck x-rays performed (diagnostic in each case), and underwent nasotracheal intubation in the operating room. There was no mortality or permanent morbidity in this group. Transferred patients were managed in a variety of ways at their referring institutions, sometimes without an artificial airway. Complications in this group included transient hypoxic encephalopathy (three children) and permanent severe encephalopathy (one child); four other children died. Blood cultures were positive for Hemophilus influenzae type b in 96% of the entire series. This study illustrates the importance of a consistent, well-organized approach to the diagnosis and management of epiglottitis, the reliability of a lateral neck x-ray, the high incidence of H. influenzae bacteremia, and the efficacy of nasotracheal intubation for maintaining airway patency in this disease.