title: Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database.
abstract: OBJECTIVE
  The aim of the study was to evaluate the factors associated with the development of severe epiglottitis in adults to provide information for physicians to make early decisions on airway management.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Adult patients admitted to acute care hospitals with a diagnosis of acute epiglottitis between January 2011 and December 2012 were identified in the Diagnosis Procedure Combination database of Japan. The main outcome measures were: 1) severe epiglottitis requiring airway intervention or resulting in early death within 2 days after admission and 2) 2-day mortality. Multivariable logistic regression analysis was performed to evaluate the association between patient characteristics and development of severe epiglottitis.
  
  
  RESULTS
  A total of 6,072 epiglottitis patients from 599 hospitals were identified. The proportion of developing severe epiglottitis was 9.4%, and 2-day mortality was 0.4%. Factors significantly associated with severe epiglottitis were older age, male sex (adjusted odds ratio [OR] 1.60; 95% confidence interval [CI], 1.28-2.00; P < .001), body mass index (BMI) >25.0 kg/m(2) (OR 1.31; 95% CI, 1.05-1.63; P = .018), diabetes mellitus (OR 1.41; 95% CI, 1.06-1.86; P = .017), epiglottic cyst (OR 2.90; 95% CI, 1.46-5.78; P = .002), pneumonia (OR 2.90; 95% CI, 1.73-4.86; P < .001), and academic hospitals (OR 1.56; 95% CI, 1.21-2.00; P = .001). Epiglottitis-related admission was summer-dominant, but seasonality was not significantly associated with severe epiglottitis.
  
  
  CONCLUSIONS
  Development of severe epiglottitis was significantly associated with older age, BMI >25.0 kg/m(2), diabetes mellitus, epiglottic cyst, or pneumonia at admission.
  
  
  METHODS
  2b.
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.|Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamasoba
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D004826:Epiglottitis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: Acute epiglottitis; airway intervention; comorbidities at admission; mortality; nationwide study