Variation in Organizational Clinical Practice Guidelines for Croup.

Area of Science:

• Pediatric Emergency Medicine
• Clinical Practice Guidelines
• Respiratory Illnesses

Background:

• Croup is a frequent pediatric emergency department (ED) diagnosis.
• Limited understanding exists regarding current clinical practice guidelines (CPGs) for croup management.
• Variability in CPGs can impact patient care and outcomes.

Purpose of the Study:

• To investigate the prevalence and characteristics of croup CPGs in US children's hospitals.
• To identify variations in treatment recommendations, admission criteria, and observation periods within these guidelines.

Main Methods:

• A survey was conducted among hospitals participating in the Pediatric Health Information System.
• Hospitals were queried for their most recent croup CPGs and any revisions.
• Data on treatment recommendations (e.g., racemic epinephrine use), observation times, and admission criteria were extracted and analyzed.

Main Results:

• Twenty out of thirty-eight (52.6%) responding hospitals had specific croup CPGs.
• Significant variation was observed in the number of racemic epinephrine doses recommended before admission (1-3 doses).
• Guidelines differed on indications for racemic epinephrine and recommended ED observation times, with most recommending less than 2 hours.

Conclusions:

• Substantial heterogeneity exists in current croup CPGs across children's hospitals.
• The findings underscore a need for developing standardized croup management protocols.
• Future standardization efforts could improve consistency and potentially optimize care for pediatric croup.