Correlating Laryngoscopic and Clinical Findings With Airway Intervention in Angioedema
Noah Thornton, Katherine Webb, Christopher N. Bowman, Minhie Willow Kwak, Naushin Ali, Ryan Stepp, Alizabeth York, James DanieroABSTRACT
Objective(s)
To evaluate whether specific presenting symptoms and laryngoscopic subsite involvement in aerodigestive angioedema predict clinical severity, defined by airway intervention, hospital admission, and length of stay (LOS). A secondary objective was to assess the performance of a reduced symptom‐based model for predicting intubation.
Methods
A retrospective cohort study was performed of adult patients presenting with aerodigestive angioedema at a single tertiary academic medical center between January 2013 and January 2023. Data were abstracted from electronic medical records. Presenting symptoms and laryngoscopic subsites of edema were recorded. The primary outcome was airway intervention. Secondary outcomes included hospital admission and LOS. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were used to assess predictors of intubation.
Results
Among 203 patients, 17 (8.4%) required intubation. Stridor (OR, 12.5; 95% CI, 2.1–73.5), odynophagia (OR, 7.6; 95% CI, 1.7–33.8), and tongue swelling (OR, 6.0; 95% CI, 1.7–20.5) were independently associated with intubation. Oropharyngeal involvement on flexible laryngoscopy was associated with a higher intubation rate (32.0% vs. 5.1%; p = 0.004) and longer LOS (mean, 4.5 vs. 2.3 days; p = 0.034). A reduced three‐variable symptom model (stridor, odynophagia, tongue swelling) demonstrated good discriminatory performance (AUC, 0.79; 95% CI, 0.67–0.91).
Conclusions
Specific presenting symptoms and oropharyngeal edema are key predictors of airway compromise in angioedema. A symptom‐only triage criteria showed strong discriminatory performance and may aid real‐time decision‐making. Prospective validation is warranted to support clinical implementation.
Level of Evidence
3.