Predictors of ENT Referral and Microlaryngobronchoscopy Findings in Children With Recurrent Croup: A 10-Year Cohort Study.

Authors

Noon Nassr, Jonathan Wareing, Victoria Ward

Published in

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. Oct 13, 2026. Epub Oct 13, 2026.

Abstract

To determine predictors of ENT referral and microlaryngobronchoscopy (MLB) findings in children with recurrent croup.
Retrospective cohort study.
Large district general NHS trust (2013-2023).
Children < 18 years with ≥ 2 croup episodes in 12 months or a clinician diagnosis of recurrent croup.
ENT referral, MLB performance and abnormal MLB findings.
128 children met recurrent croup criteria (median age 13.5 months, median 5 episodes). Sixty-two (48%) were referred to ENT, of which 34 (55%) underwent MLB. Thirteen (38%) MLBs were normal. Abnormalities included subglottic stenosis (n = 5), dynamic airway collapse (n = 4), vocal-cord pathology (n = 3), non-specific inflammatory/irritative change (n = 3) and subglottic lesions (n = 5), with the latter requiring surgical excision. Referred children were younger (median 12 vs. 17 months, p = 0.038) and had more episodes (median 5.5 vs. 4.0, p = 0.013). ENT referral correlated with ENT-related conditions (26%, p < 0.001), gastro-oesophageal reflux (24%, p = 0.021) and recurrent viral infections (47%, p = 0.022). MLB was more common with ENT-related conditions (38%, p < 0.001) and reflux (32%, p = 0.003). After adjustment, only episode count predicted ENT referral (aOR 1.09 per episode, 95% CI: 1.01-1.19), no factor predicted MLB or abnormal findings.
ENT review is warranted for recurrent croup, whereas MLB should be reserved for children with red-flag features suggesting significant airway pathology. Although most scoped children had normal or conservatively managed findings, a meaningful minority had clinically important abnormalities, including subglottic lesions requiring surgical intervention. Conventional risk factors offer little predictive value, supporting prospective multi-centre studies to refine risk-stratification.

PMID:
42866970
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.