The diagnosis and treatment of croup in children: A nationwide survey in Israel

Objectives: To determine current approaches for diagnosis and management of croup in hospitalized children in Israel. Study design: A questionnaire was sent to the 27 heads of pediatric hospitalization wards or units of infectious diseases throughout Israel. Diagnostic options included chest and neck X-ray, and arterial blood gas sampling. Treatment options included oxygen and mist, antibiotics, glucocorticoids by nebulization or systemic route, and epinephrine or beta-agonists by nebulization. Each option was rated on a 4-point scale by frequency of use: always, often, rarely and never. Results: Diagnosis: In most of the wards, chest X-ray was performed only rarely (64%); in only one ward (4%) was it done in every case. Arterial blood gases were sampled rarely or not at all in 76%. Treatment: Mist was always used in 31% of the wards and often in another 46%. Antibiotics are never prescribed. Glucocorticoids were given by systemic route to all croup patients in 4 wards (15%) and to most patients in 19 wards (73%). In only 3 wards (12%) was it rarely used. Glucocorticoids by nebulization were often or always given in 15 wards (62%) and rarely or never in 9 (38%). Finally, inhaled epinephrine was given to most patients in 17 wards (65%) and rarely in 9 (35%). Beta agonists were given often in only 2 wards (8%). Conclusion: A considerable diversity in the therapeutic approach to hospitalized children with croup in Israel, has been noted by our survey. In some of the wards new trends published in the literature are not implemented yet.