High rates of subglottic stenosis seen in African-American children admitted with severe croup to hospitals in the United States between 2003 and 2013.

BACKGROUND

To assess whether differences exist in the epidemiology and the treatment of croup with respect to gender, race, income and geographical location.

METHODS

Retrospective weighted analysis of patients under 19 admitted with a diagnosis of croup with a subcohort of patients requiring intubation or diagnostic bronchoscopy from the National Inpatient Sample and Kids' Inpatient Database from 2003 to 2013. ICD-9 codes and demographics were analyzed; cross tabulations and linear regression modeling were performed.

RESULTS

Between 2003 and 2013, 202,188 pediatric patients were admitted with a diagnosis of croup, equivalent to 1-per-100 pediatric admissions. Males were more likely to be admitted for croup than females [OR 2.13 (2.08-2.17)]. Incidence of croup is highest in Caucasians and lowest in Asian and African-American patients. African-American children are more likely to undergo diagnostic bronchoscopy or require intubation [OR 1.23 (1.08-1.401)] than other races. A higher rate of subglottic stenosis was seen in African-American children who required bronchoscopy than expected (39.1% vs 26.7%). After controlling for subglottic stenosis, African-American patients were no longer more likely to undergo diagnostic bronchoscopy or require intubation than other races [OR 1.129 (0.959-1.33)].

CONCLUSION

African-American children admitted with a diagnosis of croup appear to have an increased rate of intubation or bronchoscopy. This may be related to the high incidence of subglottic stenosis in this population. After controlling for subglottic stenosis, no difference in intervention rates was seen.