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Oropharyngeal Examination for Suspected Epiglottitis

Am J Dis Child. 1988;142(12):1262. doi:10.1001/archpedi.1988.02150120016004.
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Sir.—In their attempt to distinguish epiglottitis from laryngotracheitis, Mauro et al assessed 19 clinical findings, but they did not record the spontaneous position adopted by their patients. In our series of 30 children with epiglottitis, 14 (46%) adopted a characteristic sitting-up position and one (3%) adopted an all-fours position.1 These peculiar positions, not described in viral croup and bacterial laryngotracheitis, and a temperature higher than 38.5°C, were the main signs of epiglottitis in our series (Table).

We agree with Mauro et al that the definitive diagnosis of acute epiglottitis requires direct inspection of the epiglottis. Of our 30 patients, 17 were transferred before intubation; inspection of the epiglottis was performed on restrained children in the sitting position, after ventilation with a mask and bag; we were able to view the epiglottis adequately, and no complications occurred. On the other hand, examination in the supine position seems very hazardous: before


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