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<< Management of Airway Obstruction and Stridor in Pediatric Patients (Pharmacology CME)

Emergency Department Evaluation

History

Patient Age

The age of the patient, by itself, can guide decision-making when it comes to differential diagnosis. For example, croup is the most common cause of infectious stridor and is most prevalent in children aged 6 to 36 months. The highest risk for foreign body aspiration is in young children aged 1 to 3 years.26,27 Bacterial tracheitis is most commonly seen in children aged 6 months to 14 years, with peak occurrence between ages 3 and 8 years.28 While retropharyngeal abscess is more common in younger children, peritonsillar abscess is more common in adolescents. Similarly, mononucleosis is more prevalent among school-aged children and adolescents. Laryngomalacia, the most common cause of chronic stridor, typically presents at 2 weeks of age and resolves by 18 months.29

Timing and Onset of Symptoms

Other important considerations include timing and onset of symptoms. Acute-onset stridor in the setting of fever makes infectious etiologies such as croup, tracheitis, or epiglottitis most likely. The onset of bacterial tracheitis usually occurs over 2 to 5 days, as it is often a secondary bacterial infection, unlike croup, which is usually viral in origin and has an abrupt onset.13 While epiglottitis and tracheitis both commonly present with fever and respiratory distress, epiglottitis often has a more rapid, abrupt onset than tracheitis.19,30 Of the acute etiologies of stridor, deep neck infections typically have the slowest onset of symptoms, as the infection often progresses through several stages prior to development of an abscess that results in stridor.31 Recurrent stridor with gradual onset is most suggestive of chronic etiologies of stridor (eg, laryngomalacia, vocal cord paralysis, and tracheal stenosis).

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