Assistant Professor, Department of Paediatrics
Deputy Chief, Section of Hospital Paediatrics, Alberta Children's Hospital
Alberta Children's Hospital
2888 Shaganappi Trail NW
Calgary AB T3B 6A8
Best practices for hospitalized patients diagnosed with croup
Primary Area of Research:
Croup is a common acute respiratory viral infection that primarily affects young children. The pathophysiology of croup involves edema and inflammation of the upper airway, resulting in narrowing of the subglottic region. It is characterized by stridor, barking cough, and hoarseness and is the most common cause of stridor in febrile children.
While the majority of children with croup recover quickly with no consequences, a small proportion of cases (less than 5% of children) will require hospitalization. Furthermore, of those that are admitted to hospital, a very small proportion (less than 3%) will develop severe airway edema to the point of severe respiratory distress and complete airway obstruction. If not treated promptly with endotracheal intubation or a surgical airway, there is a very real risk of resultant hypoxia, brain injury and death.
While criteria have been established for the emergency room physician to determine who might benefit from hospital admission from those who can go home, evidence-based guidelines do not exist for the general pediatric inpatient physician to help determine which patient is safe to remain on the general ward versus those who would be better served going to an intensive care unit (ICU) setting for potential elective intubation. Anecdotal, local experience suggests that identifying these at-risk patients remains problematic and that patients continue to get to the point of near-complete obstruction “before our eyes”.
The difficulty for the clinician is to recognize this subset of very low volume, high-risk cases before complete airway obstruction occurs. Earlier recognition of these patients could allow for elective intubation in a controlled setting at a point before complete airway obstruction is imminent. This may not only prevent the potential for a hypoxic event; it would conceivably also allow for a more successful endotracheal intubation with reduced morbidity and mortality.
Through a case-control retrospective chart review The goal of this study is to identify red-flags for the most severe cases of croup so that definitive intervention (airway intubation) may occur semi-electively prior to complete airway obstruction.