Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong.

OBJECTIVES: Acute epiglottitis in adult is a potentially life-threatening condition that may be underdiagnosed. The present study reports the clinical features, management and patient outcomes in an acute hospital in Hong Kong over a seven-year period. METHOD: All adult patients aged 18 years or above admitted to Tuen Mun Hospital between July 1999 and June 2006 with the diagnosis of acute epiglottitis were included in this retrospective study. The diagnosis of acute epiglottitis was established by direct visualisation of inflamed epiglottis during laryngoscopic examination. RESULTS: 106 patients were identified. A total of 21 patients (20%) had co-morbidities, with diabetes mellitus (11%) being the most common. Five patients had a history of nasopharyngeal carcinoma and three patients had a previous history of acute epiglottitis. The majority (94%) of patients presented with sore throat as their major complaint. Blood cultures were collected from 15 patients and all were negative. A combination of cefotaxime and metronidazole was the most common empirical antibiotic regimen prescribed. Seven patients required active airway intervention (six with endotracheal intubation and one failed intubation with emergency tracheostomy performed). No mortality was reported. CONCLUSION: Acute epiglottitis in adults is not a rare entity and vigilance for this condition is needed. In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention.

An evaluation of U.S. systems for facial composite production.

Witness and victims of serious crime are normally requested to construct a facial composite of a suspect's face. While modern systems for constructing composites have been evaluated extensively in the U.K., this is not the case in the U.S. In the current work, two popular computerized systems in the US, FACES and Identikit 2000, were evaluated against a 'reference' system, PRO-fit, where performance is established. In experiment 1, witnesses constructed a composite with both PRO-fit and FACES using a realistic procedure. The resulting composites were very poorly named, but the PRO-fit emerged best in 'cued' naming and two supplementary measures: composite sorting; and likeness ratings. In experiment 2, PRO-fit was compared with Identikit 2000, a sketch-like feature system. Spontaneous naming was again very poor, but both cued naming and sorting suggested that the systems were similar. The results support previous findings that modern systems do not produce identifiable composites.

Compliance with an incident report scheme in anaesthesia.

Voluntary anonymous reporting of incidents which occur during anaesthesia is a mechanism for obtaining information about such problems. Our objective was to estimate with reporting such incidents. For 3 months, alongside the incident report form, another form, which had to be completed for every patient, was used. This form listed a series of defined events which could occur intra-operatively. Compliance with the incident reports was estimated by comparing the data obtained from the two sets of forms. Overall compliance was only about 30%. There were differences in compliance for different events. Compliance was high with more serious events and poor in the case of common events, or when successful recovery had occurred. In order to improve compliance, incident report forms should be available on each anaesthetic machine and staff should be made more aware of the fact that reportable incidents are not limited to events which harmed the patient, but also include those which could have affected patient safety.