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Paul Martinez, MD
Assistant Professor
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Title: Trend Analysis of Hospitalizations and Outcomes of Children with Croup from 1997-2016
Introduction: Croup is a common respiratory illness in children that can lead to outcomes such as intubation with mechanical ventilation, tracheostomy, cardiac arrest and/or death. The objective of this study was to describe the temporal trends in prevalence of croup in hospitalized patients and associated outcomes including intubation, tracheostomy placement and mortality from 1997-2016.
Methods: A retrospective review of the outcomes of children diagnosed with croup from 1997-2016 using the Kids’ Inpatient Database (KIDS) was performed. ICD 9 and ICD 10 codes, as well as Clinical Classifications Software codes were used to select patients with croup and various interventions. Chi-square for trend analysis was performed using StatCalc (Epi Info, CDC).
Results: Among a total of 49,178,376 discharges, 147,131 discharges were diagnosed with croup (prevalence 2.9/1,000). Among children with croup, 67.9% were males, 46% were white, and 17.4% were Hispanic. The majority of the patients were below the age of 2 years (80%). The median length of stay was 1 day (IQR: 1-2), and the majority (38%) of discharges occurred in the 4th quarter (October-December). Of the patients with croup, 3.2% had chronic complex conditions, 1.9% received mechanical ventilation and 0.1% required cardiopulmonary resuscitation. Trend analysis demonstrated a decrease in prevalence (5.1 in 1997 to 1.9 in 2016 per 1000 discharges; p< 0.001) of croup among hospitalized patients and an increase in complex chronic conditions (1.6% to 9.6%; p< 0.001) as well as an increase in invasive mechanical ventilation (1.3% to 3.4%; p< 0.001) among hospitalized patients with croup. The hospital mortality rate in children with croup was 0.03%.
Conclusions: The prevalence of croup among hospitalized children in the U.S. has decreased between 1997 and 2016. Additionally, there has been an increase in the number of children admitted with croup having chronic complex conditions as well as those who received invasive mechanical ventilation. These temporal trends may reflect an increasing number of children with mild/moderate croup being managed in the outpatient setting. This may have led to less hospitalizations but an increase in the acuity of children being admitted. Mortality among hospitalized children with croup has remained low over the past 2 decades.