Airway Risk in Angioedema: Validation of a Clinical Triage Algorithm for ENT Referral.

Abstract

To identify clinical factors associated with laryngeal involvement in patients with angioedema and to validate a triage algorithm for determining the need for nasopharyngoscopic evaluation in the emergency department (ED). A retrospective review was performed of all patients presenting to the ED with angioedema or allergic reaction between 2014 and 2019 who underwent fiberoptic laryngeal (FOL) examination. Tertiary medical center. Demographic, clinical, and endoscopic data were analyzed to identify predictors of positive FOL findings. A multivariable logistic regression model was developed and tested in an independent temporal validation cohort (2023-2025) using identical inclusion criteria. The derivation cohort included 540 patients, 46 (8.5%) of whom had laryngeal edema on FOL. Age >50, shortness of breath, edematous uvula, and history of prior angioedema were independent predictors of laryngeal involvement, while lip swelling was protective. When the resulting triage algorithm was applied to the validation cohort (n = 43), 35 patients (81.4%) would have been managed without ENT referral; none required intubation or airway intervention. The algorithm correctly identified 79.5% of patients with a normal laryngeal examination and achieved an estimated 80% reduction in ENT consultations. A simple triage algorithm based on age, shortness of breath, uvular edema, prior episodes, and lip swelling may safely guide the need for nasopharyngoscopy in patients with angioedema. Temporal validation confirmed that the approach can markedly reduce unnecessary ENT consultations without compromising airway safety. III.