Open AccessThe Role of Direct Laryngoscopy in Hospitalized Croup
Author(s) -
Hede Sannya V.,
Ongkasuwan Julina
Publication year - 2012
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599812451426a359
Subject(s) - croup , medicine , laryngoscopy , epiglottitis , incidence (geometry) , pediatrics , laryngitis , retrospective cohort study , epidemiology , bronchoscopy , airway obstruction , airway , intubation , anesthesia , surgery , physics , optics
Objective Provide insight into: 1) The frequency of viral vs bacterial hospitalized croup at Texas Children’s Hospital. 2) The epidemiology of hospitalized croup. 3) The efficacy of applying operative direct laryngoscopy and bronchoscopy (DL and B) in the detection of other significant respiratory pathology. Method A retrospective chart analysis of 345 patients with the coded diagnosis of croup at TCH between 2003 and 2011 was carried out. Patients with tracheostomy, epiglottitis, and non‐respiratory complications were excluded from the study. Patient information from children with a DL and B was compared to those without the procedure and tabulated into diagnostic and therapeutic criteria. DL and B findings were categorized as normal, grade 1 (< 50% subglottic obstruction), grade 2 (50‐70%), grade 3 (70‐90%), or grade 4 (> 90%). Results Of the 345 patients, 125 were girls (36.2%) and 224 were boys (64.9%; mean age, 3.25 years). Of these, 25 patients (7.25%) underwent operative endoscopy. Of these 25, 7 were girls and 18 were boys. Twenty‐three of 25 were of viral origin and 2 of 25 were of bacterial origin. Ten patients were febrile and 11 patients had abnormal oxygen saturation values. Of the 25 cases analyzed, DL and B findings changed management once. Conclusion Mild airway abnormalities are common in children with hospitalized croup and cannot be ruled out based on history. The data suggests that in absence of risk factors, the incidence of a significantly abnormal finding is quite low. A predictive model based on this evidence will be discussed.