Objectives: Croup is a common respiratory illness presenting to the ED and one of the most common causes of upper airway obstruction in children under 6 years. It is clinically diagnosed and enteral dexamethasone is treatment mainstay. Several small studies have described practices in other settings but no large cohort study has described ED resource utilization in croup. We aim to analyze trends in utilization of not routinely indicated resources (NRIR) in the management of croup.
Methods: Data from PHIS database was obtained and analyzed. We included encounters for children age 6 months to 12 years discharged from the ED from 2004 to 2017 with croup. Chronic conditions, asthma, other head, neck or lung infections, or where croup was a secondary diagnosis were excluded.
Results: We identified 630,432 ED visits over 14 years across 49 childrenÃ¢â‚¬â„¢s hospitals with the diagnosis of croup. 48% patients received any NRIR. Initially, NRIR utilization rates ranged around 55% of all encounters with a significant downtrend after 2013 to above 35% of all patient encounters, primarily driven by decreasing parenteral dexamethasone use with an inverse relationship to oral dexamethasone.
Conclusion: This is the first large cohort study to examine resource utilization in ED management of croup. We noted a significant decline in NRIR utilization in ED management of croup over time mainly driven by the decreasing use of parenteral dexamethasone. While NRIR rates are declining, continued high rates may be due to lack of formalized guidelines.