Do we need a change in ED diagnostic strategy for adult acute epiglottitis?

Sun Hwa Lee, Seong Jong Yun, Dong Hyeon Kim, Hyeon Hwan Jo, Seokyong Ryu

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objectives To retrospectively evaluate the diagnostic performance of qualitative and quantitative radiographic parameters for diagnosing adult acute epiglottitis, and identify the prevalence and risk factors of false-negative neck radiography-based diagnosis of acute epiglottitis. Methods An emergency physician and a radiologist independently reviewed neck radiographs of 91 patients with laryngoscopy-confirmed acute epiglottitis and 91 control subjects between March 2010 and June 2016 for qualitative and quantitative radiographic parameters of acute epiglottitis, and concluded a diagnosis. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of radiographic parameters, while independent risk factors of false-negative diagnosis were determined by multivariate logistic regression analysis. Inter-observer agreement was also calculated. Results All radiographic parameters showed good diagnostic performance with sensitivities and specificities of 33.0–80.2% and 64.8–100%, respectively. Epiglottis width (EW) > 6.3 mm showed the highest diagnostic performance (area under the ROC curve [AUC]: 0.867, sensitivity: 75.8%, specificity: 97.8%). Interobserver agreement for all radiographic parameters was excellent (range: 0.893–0.991). The lateral neck radiography-based false-negative diagnosis rate was 31.9%, and previous oral antibiotic usage was an independent risk factor of false-negative results. Conclusion EW > 6.3 mm showed the best diagnostic accuracy, facilitating a neck radiograph-based diagnosis of acute epiglottitis. However, false-negative results on neck radiograph are quite common and previous oral antibiotic usage is a risk factor. Based on the knowledge of the usefulness and risk factors of false-negative results of neck radiography, diagnostic process for acute epiglottitis using neck radiography need to be changed.

Original languageEnglish
Pages (from-to)1519-1524
Number of pages6
JournalAmerican Journal of Emergency Medicine
Issue number10
StatePublished - Oct 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.


  • Adult
  • Epiglottitis
  • False negative
  • Radiograph
  • Risk factor


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