Acute epiglottitis in infants and children.

Sixty-one cases of acute epiglottitis at the Royal Alexandra Hospital for Children, Sydney, from July 1968 to December 1974 are reviewed. The average age of 2.7 years is lower than previously reported. The average time from the initial symptom to arrival at the hospital was 14 hours. The average time from arrival to performance of tracheotomy was two hours. The diagnosis was made when first seen and assessed in 50 of the 61 cases. There were eight respiratory arrests in the Casualty and five of these were successfully resuscitated. We believe that an artificial airway is necessary in most cases, and in this series, tracheotomy was performed, with minimal complications. Particular emphasis is given to diagnosis from the history, and a detailed description is given of physical examination of the oropharynx. Although x-ray examination is usually unnecessary when the diagnosis is in doubt, a plain lateral x-ray may be useful, with due precaution not to increase the respiratory obstruction. We consider that a patient with acute epiglottitis should be transferred immediately to a major pediatric hospital, and that in almost every case an artificial airway should be established.