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Hospitalized croup (bacterial and viral): the role of rigid endoscopy
1Department of Otolaryngology, Montreal Children's Hospital, Quebec, Canada.
Insights
This study found that bacterial croup requires intubation and endoscopic evaluation. Diagnostic endoscopy is recommended for specific viral croup cases due to potential airway abnormalities like subglottic edema.
Area of Science:
- Pediatric Pulmonology
- Pediatric Otolaryngology
Background:
- Croup (laryngotracheitis) is a common pediatric respiratory illness.
- Severe croup cases may necessitate intensive care and airway intervention.
Purpose of the Study:
- To review clinical data of hospitalized croup patients.
- To identify predictors for severe disease and associated airway abnormalities.
Main Methods:
- Retrospective chart review of 500 hospitalized croup patients.
- Analysis of patient demographics, clinical history, diagnosis, and management.
Main Results:
- 2% of patients had bacterial croup, all requiring intubation and endoscopy.
- Less than one-third of viral croup patients needed intensive care.
- 6% of viral croup patients required endotracheal intubation; many had subglottic edema.
Conclusions:
- Bacterial croup necessitates aggressive airway management.
- Diagnostic laryngoscopy and bronchoscopy can reveal additional airway abnormalities in select viral croup patients.
Abstract:
This is a retrospective study of 500 cases of hospitalized patients with the diagnosis of croup (laryngotrachitis), admitted between January 1986 and August 1988, at the Montreal Children's Hospital. The patient's age, sex, clinical history, physical examination, number of admissions, season of admission, method of diagnosis, treatment and management were reviewed. Two per cent of these patients were diagnosed as bacterial croup. All of them required intubation and endoscopic evaluation in their management. Of all the viral croup patients, less than one-third were severe enough to require an intensive care setting for their management. In these patients, 6% required endotracheal intubation, and on endoscopy, a significant number of these patients had an endoscopic airway abnormality in addition to croup (subglottic edema). According to our findings, we suggest diagnostic micro-laryngoscopy and bronchoscopy be performed on certain groups of croup patients because of their higher yield of airway abnormality on endoscopy.