Rare airway issues in younger patients signal more severe angioedema: Study
Requiring management linked to longer hospital stays, higher costs
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Children and young adults with angioedema rarely require airway management to ensure an open passage for airflow, but when they do, it usually indicates more severe disease associated with longer hospital stays, higher costs, and a greater risk of death.
Those are the findings of a new study by researchers at Rutgers Robert Wood Johnson Medical School in New Jersey, who examined data from thousands of patients enrolled in the Kids’ Inpatient Database (KID), the largest publicly available U.S. database for patients younger than 21.
The scientists determined that 4% of patients required airway procedures while hospitalized. These children and young adults “had [three times] longer stays, [eightfold] higher charges, and [about 40 times] higher mortality compared” with those not needing such intervention during hospital treatment, the researchers noted.
Further, the team found disparities by race and ethnicity, and by geographic region. Specifically, Black and Hispanic patients “had significantly higher odds of intervention,” and the “Northeast and South regions had lower odds compared to the Midwest,” the researchers wrote.
Overall, the team concluded that “airway interventions in paediatric angioedema are rare but linked to significantly higher morbidity, mortality, and healthcare costs.” The researchers added that “geographic and racial disparities highlight the need to explore systemic factors shaping airway management decisions.”
The study, “Airway Intervention in Paediatric Angioedema: A National Analysis of Clinical Predictors and Outcomes,” was published in the journal Clinical Otolaryngology.
Angioedema is a form of swelling that occurs in the deeper tissues of the skin or in mucous membranes in any part of the body. If swelling occurs in the throat, it can block the airway and cause problems breathing. This constitutes a medical emergency that can be life-threatening if not treated immediately.
Investigating airway issues in US children with angioedema
In this study, the research team sought to determine how often children and young adults diagnosed with angioedema require procedures to keep their airways open — and what happens to them afterward. To that end, the researchers analyzed data from 4,238 hospital stays recorded in six of the years from 2003 to 2019 in KID.
Most hospitalizations (63%) occurred in urban teaching hospitals, the data showed. In 174, or 4% of these cases, an airway procedure was performed. These procedures were intubation, in which a breathing tube is placed into the airway, and tracheostomy, a surgical opening made in the neck to help a patient breathe.
Patients who required airway management were a median of five years older than those who did not undergo intubation or a tracheostomy (16 vs. 11 years), the researchers found.
An analysis showed the hospital stays for these patients were six versus two days, or three times longer, than those who did not require airway management. Further, their hospital charges averaged nearly $60,000 versus less than $8,000, meaning the costs were nearly eight times higher.
The proportion of patients who died during hospitalization was significantly higher among those who required airway management (6% vs. 0.15%), but medical conditions such as asthma, anaphylaxis (a severe allergic reaction), and urticaria (hives) were less common, the data showed.
The researchers noted that this pattern suggests that severe cases may be driven by excess bradykinin, a molecule that makes blood vessels leak fluid into tissues.
“Bradykinin-mediated angioedema often presents with isolated swelling and limited response to antihistamines or epinephrine,” the researchers wrote, meaning it is more difficult to treat than allergic angioedema — usually linked to asthma and urticaria — and more likely to compromise the airway, the scientists noted.
Need for airway intervention linked to higher risk of death
After accounting for factors such as age and medical conditions, Black and Hispanic patients were 5.2 and 7.8 times more likely, respectively, to undergo airway procedures than white patients, the researchers found. The reasons for these differences are unclear and may involve biological, social, or healthcare-related factors, per the team.
Patients in the Northeast and South regions of the U.S. were as much as 90% less likely to undergo airway interventions than those in the Midwest, the study also showed.
Airway interventions are relatively rare [for hospitalized children and young adults with angioedema, but] their occurrence is a strong indicator of disease severity and is associated with longer stays, higher charges, and elevated mortality.
Of the 174 total airway procedures done during the reviewed timeframe, 156 were intubations, and 17 were tracheostomies. Patients who required a tracheostomy had the most severe symptoms, per the researchers. Their median hospital stay was 27 days, or nearly one month, and median hospital charges amounted to $290,025. Nearly one-quarter of these patients died during hospitalization, the data showed.
Overall, “airway interventions are relatively rare” among hospitalized children and young adults with angioedema, the researchers wrote. However, “their occurrence is a strong indicator of disease severity and is associated with longer stays, higher charges, and elevated mortality, underscoring the need for clinical vigilance and multidisciplinary care.”
The team concluded that “this national study of paediatric angioedema hospitalizations provides insights into the burden and predictors of critical airway intervention.”
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