The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Rahul K Shah - One of the best experts on this subject based on the ideXlab platform.
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Epiglottitis in the united states national trends variances prognosis and management
Laryngoscope, 2010Co-Authors: Rahul K Shah, Carol StocksAbstract:Objectives/hypothesis To study national trends, variances, and outcomes in patients admitted with Epiglottitis in the United States. We hypothesize that the incidence of Epiglottitis has decreased, mortality has decreased, and that there has been a shift toward older patients being admitted with Epiglottitis. Study design Retrospective review of a dataset for years 1998, 2000, 2002, 2004, and 2006. Methods The Nationwide Inpatient Sample was searched using ICD-9 CM codes for Epiglottitis with obstruction (464.30) and without obstruction (464.31). Characteristics studied included patient demographics, hospital information, and admission variables. Weighted admissions were analyzed to facilitate national estimates. Results There was a trend toward decreasing admissions over the study period, from 4587.17 cases (1998) to 3772.49 cases (2006); the mean over the study period was 4062.52 cases/year. The mean age of a patient with Epiglottitis has remained relatively constant at 44.94 years over the study period; there are less frequent admissions in the 18 years and younger age cohorts, with an increase in the ages 45 to 64 years old and in patients over 85 years old. Mean length of stay is 4.15 days. Mean total charges for an admission of Epiglottitis was $17,204.02 (standard deviation, $5,894). There was a trend toward increased total charges for the management of Epiglottitis from total charges of $10,738.60 (1998) to $25,071.62 (2006). The South had a predominantly higher proportion of Epiglottitis admissions during the study period. The gender distribution remained consistent over the study years at approximately 60:40 for males:female. Mortality remained constant at approximately 36 cases per year for a national mortality rate from Epiglottitis of 0.89%. The month with the highest percentage of admissions was December; April was the month with the lowest. The majority of admissions were via the emergency department; patients were transferred in 2.88% of admissions. Over two thirds of admissions were Caucasian patients. Hospital level measures included the majority of patients were treated in an urban hospital location (82%); a minority (41%) were treated at a teaching hospital. Insurance status was private insurance in 50.02%, Medicare 20.84%, and Medicaid 12.46%. The proportion of patients that were intubated was 13.18%; 3.62% underwent a tracheotomy. Additional diagnoses in admitted patients included concomitant cardiovascular (38.75%), infectious (27.17%), respiratory (22.88%), diabetes (13.26%), and substance abuse (18.86%) diagnoses. Conclusions An 8-year retrospective review of Epiglottitis admissions revealed that Epiglottitis continues to be a significant clinical entity in the United States. The portrait of a typical patient that will be admitted with Epiglottitis is a mid-40-year-old, Caucasian, urban, male, with comorbid medical conditions, who will remain in the hospital on average for 4 days, resulting in total charges of $25,072 (2006 dollars). The majority of the mortalities are in adult patients. The majority of patients with Epiglottitis has significant medical comorbid conditions and will be managed at the admitting hospital and not be transferred. This series identifies two newly recognized and uniquely vulnerable populations for Epiglottitis: infants ( 85 years old).
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aryepiglottic abscess manifesting as Epiglottitis
Archives of Otolaryngology-head & Neck Surgery, 2009Co-Authors: Jeremy Reed, Rahul K Shah, Barbara Jantausch, Sukgi S ChoiAbstract:Acute Epiglottitis is an exceedingly rare, potentially deadly disease. Since the introduction of the Haemophilus influenzae type B (HiB) vaccine in the mid-1980s, its incidence has decreased dramatically. With the decrease in the incidence of Epiglottitis attributed to HiB came a relative increase in epiglottits caused by other pathogens. These atypical pathogens often present in an atypical manner, confusing the clinical picture and often delaying diagnosis and treatment. As the immunized portion of the population increases, atypical non-HiB epiglottis will become the rule rather than the exception. Successful management of this disease poses a particularly difficult challenge to physicians who have been trained in the post-HiB era, in which Epiglottitis is both rare and deceptive in presentation.
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airway management in pediatric Epiglottitis a national perspective
Otolaryngology-Head and Neck Surgery, 2009Co-Authors: Jason L Acevedo, Sukgi S Choi, Lina Lander, Rahul K ShahAbstract:Objectives The purpose of this study was to describe current demographics and resource utilization in the treatment of pediatric Epiglottitis. Study Design Case series from a national database. Subjects and Methods The Kids' Inpatient Database was systematically searched to extract patients under 19 years old admitted with a diagnosis of Epiglottitis and undergoing an airway intervention. Results Three hundred forty-two sampled admissions were for Epiglottitis; 40 of these patients were under the age of 19 and had an airway intervention (intubation or tracheotomy). On average, patients were 4.3 years old (SD = 6.0 years). The average length of stay was 15.6 days (SD = 33.9 and range = 0-199) with average total charges of $74,931 (SD = $163,387, range = $3342-$938,512). Multivariate analysis revealed that admission to a children's facility, admission other than via the emergency room, and nonemergent admission were associated with increased total charges. Twenty-two states reported an admission for pediatric Epiglottitis that required airway intervention. Conclusions In our sample, only 40 patients were identified who were under the age of 19 years and required an airway intervention for the treatment of Epiglottitis. Epiglottitis is a rare, expensive, and protracted disease to treat in the postvaccine era. The unique nature of this disease has implications for training future surgeons on proper management of this potentially fatal disease.
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Epiglottitis in the hemophilus influenzae type b vaccine era changing trends
Laryngoscope, 2004Co-Authors: Rahul K Shah, David W Roberson, Dwight T JonesAbstract:Objective To describe the epidemiology, natural history, and treatment of Epiglottitis in the Hemophilus influenzae type B (Hib) vaccine era. Design Ten-year retrospective study. Setting Tertiary-care children's hospital. Patients Nineteen patients with a discharge diagnosis of Epiglottitis. Intervention As indicated by the presentation of the patient, including direct laryngoscopy, intubation, intravenous antibiotics, and steroids. Main outcome measures Presentation, management, and microbiology. Results Presenting symptoms included fever, drooling, and hot potato voice. Patients' ages ranged from 15.8 months to 17.5 (mean 8.9) years. From 1992 to 1997, the mean age was 5.8 years; from 1998 to 2002, the mean age was 11.6 years. Sixty-eight percent of patients were transferred from an outside hospital. A lateral neck radiograph was recorded in 84% of patients. Mean leukocyte count was 16,600. Direct laryngoscopy with intubation was performed in 79%; intubation was for an average of 3.5 days. H. influenzae was cultured in six patients, five of which had up-to-date immunizations. The most commonly administered antibiotics were ampicillin/sulbactam and ceftriaxone. Steroids were administered to 63% of patients. Complications included deep neck space infection (2), seizure (1), recurrent illness (1), and vocal granuloma (1). There were no deaths. Conclusion The demographics, causative organisms, and natural history of Epiglottitis have changed substantially in the Hib vaccination era. The clinician evaluating and treating patients with Epiglottitis should be aware of current trends.
Connie S Price - One of the best experts on this subject based on the ideXlab platform.
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complicated adult Epiglottitis due to methicillin resistant staphylococcus aureus
American Journal of Otolaryngology, 2007Co-Authors: Lisa S Young, Connie S PriceAbstract:Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important pathogen. However, MRSA rarely causes Epiglottitis. We report an adult with Epiglottitis due to a CA-MRSA isolate of the USA300 lineage with Panton-Valentine leukocidin. Maintaining vigilance for CA-MRSA as a cause of an expanding spectrum of severe infections is warranted.
Joshua Fierer - One of the best experts on this subject based on the ideXlab platform.
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pasteurella multocida Epiglottitis
Archives of Otolaryngology-head & Neck Surgery, 1997Co-Authors: Nelar Wine, Yenny Lim, Joshua FiererAbstract:Pasteurella multocida , a small gram-negative coccobacillus, colonizes the nasopharynx and gastrointestinal tract of many animals, including cats and dogs. Most human infections with P multocida are due to animal bites, but the respiratory tract is the second most common site of infection. We describe the third case report (to our knowledge) of acute P multocida Epiglottitis. The mode of transmission in this case was inhalation of infectious nasopharyngeal secretions from cats. The patient responded well to treatment with penicillin, the drug of choice for P multocida infections. Therefore, infection with P multocida , though rare, should be considered in the differential diagnosis in any case involving acute Epiglottitis and exposure to cats. Arch Otolaryngol Head Neck Surg. 1997;123:759-761
A Belloso - One of the best experts on this subject based on the ideXlab platform.
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a rare case of necrotising Epiglottitis
Journal of Surgical Case Reports, 2011Co-Authors: J Klcova, S Mathankumara, P Morar, A BellosoAbstract:We report a case of an acute necrotizing supraglottitis in a healthy patient. Only seven cases of necrotizing Epiglottitis/supraglottitis have been reported in medical literature; all in immunocompromised patients. The features and characteristics of necrotizing Epiglottitis are discussed with review of all previously reported cases.
Carol Stocks - One of the best experts on this subject based on the ideXlab platform.
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Epiglottitis in the united states national trends variances prognosis and management
Laryngoscope, 2010Co-Authors: Rahul K Shah, Carol StocksAbstract:Objectives/hypothesis To study national trends, variances, and outcomes in patients admitted with Epiglottitis in the United States. We hypothesize that the incidence of Epiglottitis has decreased, mortality has decreased, and that there has been a shift toward older patients being admitted with Epiglottitis. Study design Retrospective review of a dataset for years 1998, 2000, 2002, 2004, and 2006. Methods The Nationwide Inpatient Sample was searched using ICD-9 CM codes for Epiglottitis with obstruction (464.30) and without obstruction (464.31). Characteristics studied included patient demographics, hospital information, and admission variables. Weighted admissions were analyzed to facilitate national estimates. Results There was a trend toward decreasing admissions over the study period, from 4587.17 cases (1998) to 3772.49 cases (2006); the mean over the study period was 4062.52 cases/year. The mean age of a patient with Epiglottitis has remained relatively constant at 44.94 years over the study period; there are less frequent admissions in the 18 years and younger age cohorts, with an increase in the ages 45 to 64 years old and in patients over 85 years old. Mean length of stay is 4.15 days. Mean total charges for an admission of Epiglottitis was $17,204.02 (standard deviation, $5,894). There was a trend toward increased total charges for the management of Epiglottitis from total charges of $10,738.60 (1998) to $25,071.62 (2006). The South had a predominantly higher proportion of Epiglottitis admissions during the study period. The gender distribution remained consistent over the study years at approximately 60:40 for males:female. Mortality remained constant at approximately 36 cases per year for a national mortality rate from Epiglottitis of 0.89%. The month with the highest percentage of admissions was December; April was the month with the lowest. The majority of admissions were via the emergency department; patients were transferred in 2.88% of admissions. Over two thirds of admissions were Caucasian patients. Hospital level measures included the majority of patients were treated in an urban hospital location (82%); a minority (41%) were treated at a teaching hospital. Insurance status was private insurance in 50.02%, Medicare 20.84%, and Medicaid 12.46%. The proportion of patients that were intubated was 13.18%; 3.62% underwent a tracheotomy. Additional diagnoses in admitted patients included concomitant cardiovascular (38.75%), infectious (27.17%), respiratory (22.88%), diabetes (13.26%), and substance abuse (18.86%) diagnoses. Conclusions An 8-year retrospective review of Epiglottitis admissions revealed that Epiglottitis continues to be a significant clinical entity in the United States. The portrait of a typical patient that will be admitted with Epiglottitis is a mid-40-year-old, Caucasian, urban, male, with comorbid medical conditions, who will remain in the hospital on average for 4 days, resulting in total charges of $25,072 (2006 dollars). The majority of the mortalities are in adult patients. The majority of patients with Epiglottitis has significant medical comorbid conditions and will be managed at the admitting hospital and not be transferred. This series identifies two newly recognized and uniquely vulnerable populations for Epiglottitis: infants ( 85 years old).
