Acute supraglottitis in adults: early indicators of airway obstruction

To show that cardinal signs of upper airway obstruction are characteristically absent in the early phases of potentially fatal supraglottitis.

The hospital records of 9 previously healthy adults who died from autopsy-proven supraglottitis within 12 hours after sudden onset of severe sore throat.

Six patients who were discharged from the emergency room with a diagnosis of pharyngitis died at home within 4 hours after dismissal. Three patients suspected of supraglottitis were admitted and treated medically; by the time signs of respiratory obstruction appeared, attempts at airway intervention failed. None of the 9 patients presented with symptoms or signs of respiratory distress, but all gave a history of fulminant sore throat associated with chills and fever. In all patients, the pulse rate was above 100 per minute.

In the early phases of acute supraglottitis, the most reliable indicator of impending airway obstruction is a rapidly developing severe sore throat. Dyspnea, tachypnea, retractions, stridor, and cyanosis are manifestations of advanced stages of the infection and should not be awaited to determine the need for airway intervention.