title: Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study.
abstract: OBJECTIVE
  Determine which risk factors in children with recurrent croup warrant bronchoscopic evaluation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary paediatric hospital.
  
  
  METHODS
  Children with recurrent croup who underwent a rigid bronchoscopy between 2001 and 2013.
  
  
  METHODS
  Bronchoscopy findings, classified as normal, mildly abnormal or significantly abnormal.
  
  
  RESULTS
  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 (P = 0.02), have a previous intubation (P = 0.002) or be younger than 3 years old (P = 0.01).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Duval
authors.affiliation: Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
authors.forename: G
authors.initials: G
authors.lastname: Tarasidis
authors.affiliation: Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Grimmer
authors.affiliation: Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
authors.forename: H R
authors.initials: HR
authors.lastname: Muntz
authors.affiliation: Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
authors.forename: A H
authors.initials: AH
authors.lastname: Park
authors.affiliation: Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.affiliation: Division of Pediatric Pulmonology, University of Utah, Salt Lake City, UT, USA.
authors.forename: F
authors.initials: F
authors.lastname: Asfour
authors.affiliation: Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
authors.forename: J
authors.initials: J
authors.lastname: Meier
mesh_terms: D000293:Adolescent; D058109:Airway Management / Q000379:methods*; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology; D001249:Asthma / Q000150:complications / Q000175:diagnosis*; D001999:Bronchoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies