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Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study
M Duval1, G Tarasidis1, J F Grimmer1
1Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
Insights
In children with recurrent croup, significant bronchoscopy findings requiring intervention are uncommon. Risk factors like chronic cough, prior intubation, or young age may indicate the need for evaluation.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Pediatric Gastroenterology
Background:
- Recurrent croup in children can be challenging to manage.
- Identifying risk factors for significant airway abnormalities is crucial for appropriate intervention.
Purpose of the Study:
- To determine risk factors in children with recurrent croup that warrant bronchoscopic evaluation.
- To assess the prevalence of significant findings on bronchoscopy in this population.
Main Methods:
- Retrospective cohort study of children with recurrent croup undergoing rigid bronchoscopy.
- Analysis of bronchoscopy findings (normal, mildly abnormal, significantly abnormal).
- Multivariate analysis to identify associations with significant findings.
Main Results:
- 11.5% of children had significant bronchoscopy findings requiring intervention.
- Significant findings were associated with chronic cough, previous intubation, and age under 3 years.
- Gastro-oesophageal reflux (GERD) was suggested in nearly half of the patients.
Conclusions:
- Significant bronchoscopic findings requiring surgical intervention are infrequent in children with recurrent croup.
- Empiric medical management may be considered for patients without clear risk factors before endoscopy.
- Further investigation into GERD as a contributing factor is warranted.
Objective:
Determine which risk factors in children with recurrent croup warrant bronchoscopic evaluation.
Design:
Retrospective cohort study.
Setting:
Tertiary paediatric hospital.
Participants:
Children with recurrent croup who underwent a rigid bronchoscopy between 2001 and 2013.
Main Outcome Measures:
Bronchoscopy findings, classified as normal, mildly abnormal or significantly abnormal.
Results:
Two hundred and thirty-five children underwent a rigid bronchoscopy and 110 underwent a flexible oesophagoscopy. One hundred and forty-five children (61.7%) had a mildly abnormal exam, and 27 children (11.5%) had significant findings that required a surgical intervention or grade 2 or greater subglottic stenosis. The significantly abnormal group included 4 children with laryngomalacia, 2 with a subglottic cyst, 8 with grade 2 or 3 subglottic stenosis and 13 children who underwent a surgical procedure for subglottic stenosis. Sixty-seven children had a preoperative diagnosis of asthma, 62 were atopic and 78 had symptoms of gastro-oesophageal reflux. Oesophagoscopy was diagnostic of gastro-oesophageal reflux in 19 of 110 cases, and 106 children (45.1%) had bronchoscopic findings suggestive of GERD. Eight children had eosinophilic oesophagitis. After multivariate analysis, significantly abnormal bronchoscopy was significantly associated with chronic cough (P = 0.02), have a previous intubation (P = 0.002) or be younger than 3 years old (P = 0.01).
Conclusion:
Significant findings on bronchoscopy that warranted further surgical intervention were uncommon in this cohort. Nearly half of the patients had evidence of gastro-oesophageal reflux. In patients without risk factors for significant abnormalities, empiric medical management may be beneficial prior to endoscopy.
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