Airway Endoscopy Findings in Children with Recurrent Croup

Microlaryngoscopy and bronchoscopy (MLB) is frequently performed to identify subglottic pathology in recurrent croup. However, the reported incidence of positive findings that could alter management or require intervention varies widely. We sought to determine the utility of endoscopic airway evaluation in this setting.

All MLBs performed by three pediatric otolaryngologists at a tertiary care academic children's hospital from January 1, 2019, to December 31, 2023, were retrospectively reviewed.

Sixty-two MLBs were performed for recurrent croup. Forty-four (71.0%) patients were male. The mean age was 4.3 years (95% confidence interval, 3.7-4.9). Ten (16.1%) patients were born preterm. Despite serving a predominantly Medicaid-insured minority population, 59.7% of the referred children were privately insured and 85.5% were white. Twenty-one (33.9%) had abnormal findings on MLB, though most were relatively minor. Only 3 (4.8%) patients demonstrated subglottic stenosis, two classified as Cotton-Myer grade I and one as grade II, with the latter undergoing dilation. Preterm birth, younger age, history of intubation, or inpatient otolaryngology consultation were significantly associated with abnormal findings on MLB.

MLB performed in children with recurrent croup has a low incidence of subglottic pathology. Those who could benefit from surgical intervention have characteristics that could identify them preoperatively. Healthcare disparities may significantly influence patterns of referral for MLBs. These results could help the discussion around procedure appropriateness and shared decision-making with caregivers.