Role of direct laryngoscopy and bronchoscopy in recurrent croup

Objective. To determine risk factors in children with recurrent croup that predict moderate/severe findings on direct laryngoscopy and bronchoscopy and need for further operative interventions. Study Design. Retrospective chart review cohort. Setting. Tertiary care children's hospital. Subjects and Methods. Retrospective chart review of 103 patients diagnosed with recurrent croup who underwent diagnostic laryngoscopy and bronchoscopy from January 2004 to August 2013. Statistical analysis determined risk factors significantly associated with moderate/severe operative findings. A probability tree was formulated. Results. Of 103 patients, 30.1% had history of intubation, 6.8% had a history of subglottic stenosis, 6.8% had a history of previous airway procedure, 11.7% consultations were inpatient, 64.1% had asthma, 47.6% had seasonal allergies, 60.2% had gastroesophageal reflux disease, 15.5% were aged ≤12 months, and 51.5% were ≤36 months. Statistically significant risk factors in predicting moderately/severely abnormal operative findings included consultation location (P = .010), history of intubation (P = .003), age younger than 36 months (P = .013), and seasonal allergies (P = .035). When using location of consultation, history of intubation, and age in a statistical model, diagnostic accuracy equaled 93.5%. Of children without history of intubation but who underwent inpatient otolaryngology consultation, 28.6% had moderate/ severe findings. Likewise, 41.2% of children with a history of intubation who were younger than 36 months of age had moderate/severe findings. Conclusion. Moderate to severe operative findings are encountered in only 8.7% of children with recurrent croup. Using statistical modeling, 2 high-risk groups are (1) patients without a history of intubation but inpatient consultation and (2) patients with a history of intubation and age younger than 36 months.