Management Patterns of Croup in Korean Emergency Departments: A Nationwide Cohort Study

Abstract

Highlights What are the main findings? center dot Despite guideline recommendations, only around half of children with croup in Korean emergency departments received corticosteroids. center dot Dedicated pediatric emergency centers (DPECs) were associated with lower use of potentially low-value interventions (salbutamol and chest and cervical radiography) than general emergency centers (GECs). What is the implication of the main finding? center dot Education and implementation of standardized national clinical guidelines are needed to optimize croup management in Korean emergency departments. Background: Despite the established importance of prescribing steroids to children with croup, many physicians in Korean emergency departments (EDs) do not adhere to this recommendation. This study aimed to evaluate treatment appropriateness by investigating steroid prescription rates and potentially low-value interventions such as salbutamol nebulizers and radiographs and to compare dedicated pediatric emergency centers (DPECs) and general emergency centers (GECs) to understand treatment trends for croup in Korea. Methods: This retrospective cohort study analyzed a 5% random sample of the National Health Screening Program for Infants and Children (NHSPIC) cohort linked to the National Health Insurance Service database (2008-2015). The study included children with a primary diagnosis of croup and excluded children who were prescribed oral or steroid injections within three days before their ED visit. The primary outcome was steroid prescription rate; secondary outcomes included comparisons of management patterns between DPECs and GECs. Results: The overall steroid prescription rate was 56.9%. Steroid prescribing was slightly higher in DPECs than in GECs (61.2% vs. 56.3%, p = 0.131). In contrast, DPECs had lower prescription rates for salbutamol nebulizers (4.5% vs. 12.7%, p < 0.001), chest radiographs (65.3% vs. 78.7%, p < 0.001), and cervical spine radiographs (4.5% vs. 12.6%, p < 0.001). Steroid prescription rates showed no significant temporal trend, while potentially low-value interventions decreased significantly. Conclusions: Only about half of children with croup in Korean EDs received steroids. DPECs were associated with lower use of potentially low-value interventions, suggesting more guideline-concordant practice. Education and implementation of standardized national croup clinical guidelines are needed to optimize care.