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Variations in How Children’s Hospitals Treat Croup Are Barking For Some Attention :

April 7, 2017

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. 

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.

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