With the arrival of outpatient usage of oral dexamethasone for severe croup, we have not seen many studies on this respiratory illness in peer-reviewed journals, thinking everyone is diagnosing and managing the illness similarly. Yet variations can and do occur per a retrospective cohort study being shared this week by Tyler et al. (10.1542/peds.2016-3582) who present data from a national database of 26 freestanding children’s hospitals (the Pediatric Health Information Service database) of children between 6 months and 15 years diagnosed with croup. The authors looked at variation in non-routinely indicated resources such as chest and lateral neck films, viral testing, parenteral steroids and even antibiotics. More than 6200 patients were reviewed and sadly marked variability up to a 5-fold difference in non-routinely indicated resources were identified attributable to specific hospital practice patterns and not to any particular clinical guideline or pathway.
At a time when we want to manage populations of patients with underuse of non-recommended tests and procedures, this study lays out a problem we may not have recognized as dramatically as the results suggest—the variability in ancillary testing and treatments for croup. This study coughs up a lot of useful information to think about rather than necessarily order for your patients, so take a deep breath, read the study, and then see if it changes or at least attempts to better standardize your care of croup patients by adhering to evidence-based guidelines.