Variation in Inpatient Croup Management and Outcomes

Area of Science:

• Pediatric hospital medicine
• Healthcare quality improvement
• Clinical resource utilization

Background:

• Croup is typically a clinical diagnosis; ancillary testing is rarely indicated.
• Limited evidence exists for inpatient croup management.
• Variability in healthcare resource use is a concern.

Purpose of the Study:

• To describe variation in the use of not routinely indicated resources (NRIRs) for inpatient croup.
• To identify predictors of this variation.

Main Methods:

• Retrospective cohort study using the Pediatric Health Information System database.
• Included 6236 generally healthy inpatients aged 6 months to 15 years with croup.
• Analyzed variability in chest radiographs, neck radiographs, viral testing, parenteral steroids, and antibiotics using risk-adjusted analysis.

Main Results:

• Significant variability in NRIR utilization was observed across 26 hospitals.
• Hospital-specific practice patterns, not patient characteristics, were the primary drivers of this variation.
• Up to a fivefold difference in NRIR use was attributed to hospital-level practices.

Conclusions:

• Marked variability exists in the utilization of NRIRs for inpatient croup.
• Hospital-level practice variation significantly impacts resource use.
• There is a need for evidence-based guidelines and quality improvement initiatives to standardize care and reduce unnecessary resource utilization.