Factors predicting hospitalization of pediatric patients with croup presenting to the emergency department: a retrospective cross-sectional study

Croup is the most common cause of acute, acquired upper airway obstruction in pediatric patients. Severe upper airway obstruction in children can quickly progress to respiratory failure; early and accurate diagnosis and treatment are essential. We examined the characteristics of pediatric patients with croup who visited our emergency department and required hospitalization even after appropriate treatment. We retrospectively studied patients who visited the pediatric emergency department of a tertiary hospital in Gyeonggi-do, Korea, from January 2018 to December 2021. After diagnosis and treatment using a defined protocol, all patients were divided into two groups: those who were hospitalized because they did not meet the criteria for discharge, and those who returned home. A multivariate logistic regression analysis was performed to identify factors associated with hospitalization. We studied 212 patients with an average age of 14 (12-16) months; 68 (32.0%) patients were female and 144 (67.9%) were male. In total, 47 (22.1%) patients were admitted for additional treatment. The multivariate logistic regression analysis revealed that tachycardia, tachypnea, decreased urine output and chest retraction were associated with hospitalization. A nomogram was constructed. Tachycardia, tachypnea, decreased urine volume and chest retraction in pediatric patients with croup showed a relationship with upper airway obstruction that persisted after treatment. If any of the above symptoms are observed in the emergency department, close observation is needed to determine whether respiratory failure is progressing; if so, prompt treatment is required.