Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study. (June 2015)

• Record Type: Journal Article
• Authors: Duval, M.; Tarasidis, G.; Grimmer, J.F.; Muntz, H.R.; Park, A.H.; Smith, M.; Asfour, F.; Meier, J.
• Is Part Of: Clinical otolaryngology. Volume 40:Number 3(2015:Jun.)
• Page Start: 227
• Page End: 233
• Publication Date: 2015-06
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1111/coa.12353
• Languages: English
• ISSNs: 1749-4478

Abstract

<abstract abstract-type="main" id="coa12353-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="coa12353-sec-0001" sec-type="section"> <title>Objective</title> <p>Determine which risk factors in children with recurrent croup warrant bronchoscopic evaluation.</p> </sec> <sec id="coa12353-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="coa12353-sec-0003" sec-type="section"> <title>Setting</title> <p>Tertiary paediatric hospital.</p> </sec> <sec id="coa12353-sec-0004" sec-type="section"> <title>Participants</title> <p>Children with recurrent croup who underwent a rigid bronchoscopy between 2001 and 2013.</p> </sec> <sec id="coa12353-sec-0005" sec-type="section"> <title>Main outcome measures</title> <p>Bronchoscopy findings, classified as normal, mildly abnormal or significantly abnormal.</p> </sec> <sec id="coa12353-sec-0006" sec-type="section"> <title>Results</title> <p>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 (<italic>P</italic> = 0.02), have a previous intubation (<italic>P</italic> = 0.002) or be younger than 3 years old (<italic>P</italic> = 0.01).</p> </sec> <sec id="coa12353-sec-0007" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>