Differentiation of epiglottitis from laryngotracheitis in the child with stridor
R. D. Mauro, S. R. Poole and C. H. Lockhart
Department of Pediatrics, Children's Hospital, Denver.
To identify which clinical findings serve to differentiate acute
epiglottitis from laryngotracheitis and also to evaluate the role of direct
inspection of the epiglottis in the evaluation of children initially
thought to have laryngotracheitis, we prospectively evaluated 155 children
presenting to the emergency room with acute stridor. Three of the findings
on physical examination were associated with epiglottitis: absence of
spontaneous cough, drooling, and agitation. The diagnosis assigned prior to
inspection of the epiglottis was incorrect in two of six patients with
epiglottitis and in three of 149 patients with laryngotracheitis. The
diagnosis made after inspection was correct in all 155 patients. Minor
complications of inspection were seen in seven patients with
laryngotracheitis. No complications were seen in the children with
epiglottitis. We conclude that drooling, agitation, and absence of cough
are predictors of epiglottitis, but clinical findings alone cannot exclude
epiglottitis in every child who appears to have laryngotracheitis. When
laryngotracheitis is the suspected diagnosis, inspection of the epiglottis
by a pediatrician in a hospital emergency room is an effective aid to the
evaluation of the child with acute stridor.
