Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study

ObjectiveDetermine which risk factors in children with recurrent croup warrant bronchoscopic evaluation. DesignRetrospective cohort study. SettingTertiary paediatric hospital. ParticipantsChildren with recurrent croup who underwent a rigid bronchoscopy between 2001 and 2013. Main outcome measuresBronchoscopy findings, classified as normal, mildly abnormal or significantly abnormal. ResultsTwo 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 (P=0.02), have a previous intubation (P=0.002) or be younger than 3years old (P=0.01). ConclusionSignificant 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.