A national study from the Better Assessment and Response to Croup in Kids (BARCK) collaborative found significant differences in how children with croup are treated at hospitals and urgent care centers across the United States, highlighting opportunities to improve consistency in care.
The study, published in Hospital Pediatrics, examined practices at 107 hospitals and clinical sites participating in BARCK, a quality improvement initiative within the Pediatric Acute and Critical Care Quality Network of the American Academy of Pediatrics. Nearly 90% of sites completed the survey, but only about half reported having a formal clinical pathway for treating croup.
Researchers found substantial variation in treatment recommendations, including when children should be admitted to the hospital, when steroids such as dexamethasone should be used, and whether imaging tests like neck or chest X-rays should be ordered. Many pathways also included testing not routinely recommended for typical cases.
The UC Riverside pediatric hospitalist group at Eisenhower Health participated in the national collaborative. Dr. Nancy Chung, site lead for the study effort at Eisenhower and a health sciences associate clinical professor of pediatrics at the UC Riverside School of Medicine, said the project aims to reduce unnecessary hospital admissions and testing while improving consistency of care.
“One of the goals was to see whether children could safely go home after two doses and only be admitted if they later required a third dose,” Chung said.
Croup is a common viral illness that causes swelling in the upper airway, leading to a distinctive barking cough and noisy breathing. More severe cases are often treated with a combination of steroids typically given orally and racemic epinephrine, an inhaled medication that quickly reduces airway swelling and helps children breathe more easily.
Historically, children who required two doses of racemic epinephrine were often admitted to the hospital out of concern they would need additional treatments. However, Chung said newer research suggests many children do not require further doses after admission.
“There are often investigations that may not necessarily need to be done, particularly neck X-rays, chest X-rays, blood work and respiratory investigations,” Chung said. “If we standardize therapy, then we’re all talking the same language.”
The BARCK collaborative brings together specialists in pediatric emergency medicine, hospital medicine, intensive care, otolaryngology, urgent care, and quality improvement. Investigators say the study provides an important baseline for future efforts to improve evidence-based care and reduce unnecessary variation in croup treatment nationwide.
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