Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study

• Published in: Clinical otolaryngology Vol. 40; no. 3; pp. 227 - 233
• Main Authors: Duval, M., Tarasidis, G., Grimmer, J.F., Muntz, H.R., Park, A.H., Smith, M., Asfour, F., Meier, J.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2015; Wiley Subscription Services, Inc
• Subjects: Adolescent; Airway Management - methods; Airway Obstruction - diagnosis; Airway Obstruction - etiology; Asthma - complications; Asthma - diagnosis; Bronchoscopy - methods; Child; Child, Preschool; Esophagoscopy - methods; Female; Follow-Up Studies; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnosis; Humans; Infant; Infant, Newborn; Intraoperative Care; Laryngoscopy - methods; Male; Recurrence; Retrospective Studies
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.12353

Objective Determine which risk factors in children with recurrent croup warrant bronchoscopic evaluation. Design Retrospective cohort study. Setting Tertiary paediatric hospital. Participants Children with recurrent croup who underwent a rigid bronchoscopy between 2001 and 2013. Main outcome measures Bronchoscopy findings, classified as normal, mildly abnormal or significantly abnormal. Results Two hundred and thirty‐five children underwent a rigid bronchoscopy and 110 underwent a flexible oesophagoscopy. One hundred and forty‐five children (61.7%) had a mildly abnormal exam, and 27 children (11.5%) had significant findings that required a surgical intervention or grade 2 or greater subglottic stenosis. The significantly abnormal group included 4 children with laryngomalacia, 2 with a subglottic cyst, 8 with grade 2 or 3 subglottic stenosis and 13 children who underwent a surgical procedure for subglottic stenosis. Sixty‐seven children had a preoperative diagnosis of asthma, 62 were atopic and 78 had symptoms of gastro‐oesophageal reflux. Oesophagoscopy was diagnostic of gastro‐oesophageal reflux in 19 of 110 cases, and 106 children (45.1%) had bronchoscopic findings suggestive of GERD. Eight children had eosinophilic oesophagitis. After multivariate analysis, significantly abnormal bronchoscopy was significantly associated with chronic cough (P = 0.02), have a previous intubation (P = 0.002) or be younger than 3 years old (P = 0.01). Conclusion Significant findings on bronchoscopy that warranted further surgical intervention were uncommon in this cohort. Nearly half of the patients had evidence of gastro‐oesophageal reflux. In patients without risk factors for significant abnormalities, empiric medical management may be beneficial prior to endoscopy.