Better Assessment and Responses to Croup in Kids (BARCK)

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Acute laryngotracheobronchitis, or croup, accounts for approximately 15% of emergency room presentations for patients 6 months to 3 years of age. Despite well-established treatment recommendations, high variability in management and disposition persists across the country. This quality improvement initiative aimed to improve evidence-based evaluation and management of children with croup at Helen DeVos Pediatric Emergency Department by: reducing preventable hospitalization by 20% from baseline, decreasing non-routinely recommended diagnostic testing (neck radiographs, chest radiographs, viral testing, laboratory studies) by 50% from baseline, and increasing appropriate oral dexamethasone administration to at least 95% of eligible patients. Metrics were compared to national averages through the American Academy of Pediatrics Pediatric Acute and Critical Care Quality Network.

Data were collected through Epic query of encounters with primary diagnostic ICD-10 codes for acute laryngitis, acute laryngotracheitis, and croup. Twenty patient encounters were randomly selected from each 2-week period. Cycles from a 7-month baseline period were collected and analyzed through a QIDA Redcap Database and compared to averaged data from 104 pediatric emergency departments and urgent care centers nationwide. Following baseline analysis, investigators completed educational sessions on evidence-based croup management, disseminated to providers at each center. Data were then collected and analyzed for a subsequent 7-month period using identical variables to assess post-intervention outcomes.

Pre-intervention oral dexamethasone administration was 98%, exceeding both the project goal (95%) and the national average (93.55%). Post-intervention rates remained at 98%. Preventable hospitalizations increased from 1.85% pre-intervention to 2.00% post-intervention (absolute difference: 0.15%), falling short of the 20% reduction goal. However, both pre- and post-intervention rates remained below national averages (4.97% and 4.10%, respectively). Non-essential testing (neck/chest radiograph, viral testing, blood cultures, inflammatory markers) increased from 3.63% to 7.30% of visits post-intervention. Despite this increase, institutional rates remained substantially lower than national averages (15.13% pre-intervention, 12.83% post-intervention). Formal statistical comparisons between institutional and national data will be conducted in future research phases.

This study demonstrates high baseline adherence to evidence-based practices prior to intervention. More than 95% of patients received oral corticosteroids, preventable hospitalizations were avoided, and unnecessary diagnostic studies were minimized. Although the educational intervention did not yield improvements, institutional performance exceeded national benchmarks. Existing clinical practices were already well-aligned with evidence-based standards, potentially limiting intervention impact.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2112

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