A new study has developed and validated a risk score to assist clinicians in predicting the need for intubation among patients with hereditary angioedema (HAE) who present at the Emergency Department (ED).

The study, published in the American Journal of Emergency Medicine, used a retrospective chart review of patients in the ED to develop a model that would predict the need for intubation among patients with HAE.

“The cornerstone of management of angioedema is airway assessment, monitoring, and early endotracheal intubation when indicated,” the authors wrote. “In this retrospective study, we identify important clinical predictors of airway compromise to devise a clinical risk score that may help guide clinicians in their disposition and management of patients presenting with angioedema of the face, mouth, or larynx.”


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The research team reviewed the medical records of 594 patients with HAE who presented at the ED. The patient data was divided into two groups, a training set and a test set, and the training set was used to assess risk factors for intubation. The authors then developed a model and risk score for intubation prediction, which they then applied to the test set for validation.

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The analysis revealed shortness of breath, hypertension, drooling, and anterior tongue or pharyngeal swelling to be independent risk factors for intubation. The authors note that there is some evidence that the anatomic site of swelling is associated with the need for intubation, and their model concurred, finding more need for intubation in cases of pharyngeal edema than in those with anterior tongue edema.

The authors caution that they conducted their study at a single center and that the risk score still requires external validation in further studies before widespread clinical adoption can be recommended. With validation, such a scoring algorithm for emergency healthcare staff could represent a promising diagnostic tool for patients with HAE.

Reference

Arthur J, Caro D, Topp S, et al. Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2023;63:44-49. doi: 10.1016/j.ajem.2022.10.017