Broad differences in care were primarily based on variation in hospital-level practice, not patient severity of illness. Evidence-based data supporting best practices for inpatient croup management are sparse. Now, researchers have assessed variation in inpatient management of croup and its association with patient outcomes using retrospective data from 26 U.S. children’s hospitals. The study cohort comprised 6236 children aged >6 months and < 14 years who were admitted for croup. Data on first admissions were used. Investigators assessed the use of not routinely indicated resources (NRIRs) across hospitals. NRIRs included parenteral steroids (instead of oral), viral diagnostic studies, chest radiographs (CXRs), lateral neck radiographs, and antibiotics. Use of NRIRs varied greatly — by up to fivefold (for parenteral steroids) — between hospitals. Receipt of ≥2 NRIRs occurred in 29% of patients overall (median) but ranged from 16% to 61% across hospitals. For specific NRIRs, median use of CXRs was 24% (range, 9%-44%), median use of antibiotics was 9% (range, 4%-15%), and median use of parenteral steroids was 41% (range, 16%-88%). Despite variation in resource use, there was no significant variability in patient outcomes of tracheal intubation, return to emergency department within 7 days, or 30-day readmission between the hospitals with the lowest use of NRIRs and those with the highest use. With the exception of antibiotics, hospital-specific effects were shown to be the primary predictor of use ofNRIRs.
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