Croup versus epiglottitis

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Croup versus epiglottitis

Peter Radell, MD, PhD and Sten Lindahl, MD, PhD, FRAC

Respiratory distress is one of the most common presenting symptoms among pediatric patients emergency departments and one of the most common reasons for admission to general pediatric intensive care units. Both acute epiglottitis (supraglottic inflammation) and croup (laryngotracheobronchitis or spasmodic croup, subglottic inflammation) present with evidence of airway obstruction. In 80% of all pediatric patients with acquired stridor, infection is the cause. Of these, 90% are due to laryngotracheobronchitis, and a minority are cases of epiglottitis. Other causes of respiratory distress, such as a foreign body, subglottic stenosis, bacterial tracheitis, and retropharyngeal abscess, also must be considered in the differential diagnosis.

Vaccination against Haemophilus influenzae has resulted in a dramatic reduction in the incidence of epiglottitis in children since the late 1980s. The incidence in adults has been less affected, and the prevalence of other bacterial infections—e.g. Staphylococcus, Streptococcus, Klebsiella, Pseudomonas—has increased relatively.

Because of the possibility of rapid clinical progression to complete obstruction, acute epiglottitis requires early and prompt intervention. To provide the appropriate therapeutic interventions, one must be able to differentiate between acute epiglottitis and laryngotracheobronchitis. Table 205-1 compares these two causes of severe stridor.

Table 205-1

Acute Epiglottitis Versus Croup

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Clinical Feature Acute Epiglottitis Croup
Age (years) 3-7 0.5-5
Family history No Yes
Prodrome Usually none ± dysphagia Usually URI
Onset Abrupt (6-24 h) Gradual (days)
Clinical course Rapid, may progress to cardiorespiratory arrest Usually self-limited
Signs and symptoms
Temperature (° C) 38-40 38
Hoarseness No Yes
Dysphagia Yes No
Dyspnea Severe No
Inspiratory stridor Yes Yes
Appearance Toxic, anxious, sitting upright, leaning forward, mouth open, exaggerated sniffing position Nontoxic

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