Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema

• Published in: The American journal of emergency medicine Vol. 63; pp. 44 - 49
• Main Authors: Arthur, Jason, Caro, David, Topp, Stephen, Chadwick, Steven, Driver, Brian, Henson, Morgan, Norse, Ashley, Spencer, Horace, Godwin, Steven A., Guirgis, Faheem
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2023; Elsevier Limited
• Subjects: Airway; Allergic reaction; Angioedema; Critical care; Documentation; Edema; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Emergency Treatment; Humans; Hypertension; Intubation; Intubation, Intratracheal; Medicare; Ostomy; Patients; Pharynx; Regression analysis; Retrospective Studies; Saliva; Variables; Critical care; Airway; Allergic reaction; Angioedema
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2022.10.017

The objective of this study is to identify predictors of airway compromise among patients presenting to the emergency department with angioedema in order to develop and validate a risk score to augment clinician gestalt regarding need for intubation. Retrospective chart review of emergency department patients with a diagnosis of angioedema. After data extraction they were randomly divided into a training and test set. The training set was used to identify factors associated with intubation and to develop a model and risk score to predict intubation. The model and risk score were then applied to the test set. A total of 594 patients were included. Past medical history of hypertension, presence of shortness of breath, drooling, and anterior tongue or pharyngeal swelling were independent predictors included in our final model and risk score. The Area Under the Curve for the Receiver Operator Characteristic curve was 87.55% (83.42%–91.69%) for the training set and 86.1% (77.62%–94.60%) for the test set. A simple scoring algorithm may aid in predicting angioedema patients at high and low risk for intubation. External validation of this score is necessary before wide-spread adoption of this decision aid.