Croup Presentations to Emergency Departments in Alberta, Canada: a Large Population-based Study

Background: Croup is a common pediatric respiratory illness. While croup is generally a mild disease, exacerbations may be seen in the Emergency Department (ED) setting. The objective of this study was to describe the epidemiology of croup presentations to EDs made by infants (<or=2 years old) in the province of Alberta, Canada.

Methods: The Ambulatory Care Classification System and other Alberta provincial administrative databases were used to obtain all ED encounters for croup during six fiscal years (April 1999 to March 2005). Information extracted included demographics, ED visit timing, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates.

Results: There were 27,355 ED visits for croup made by 20,019 infants. Most (78.2%) had only one croup-related ED visit; males (62.3% of ED visits) more commonly presented than females. Biennial trends were apparent in the sex standardized visit rates which increased from 43.4/1,000 in 1999/2000 to 49.6/1,000 in 2003/2004 for odd fiscal years, and from 30.9/1,000 in 2000/2001 to 34.1/1,000 in 2004/2005 for even years. The directly standardized visit rates varied by socio-economic proxy: generally Welfare recipients had the highest rates, Aboriginals the lowest. Admission occurred in 8.0% of the cases; 5.4% had a repeat ED visit within 7 days following discharge. Overall, 71.9% of individuals had yet to have a non-ED follow-up visit by 1 week; the estimated median time to the first follow-up visit was 33 days (95% CI: 31-36).

Conclusion: Croup is a common presenting problem in Alberta EDs. The important findings include an overall increase in the rates of presentation over the study period, disparities based on age, sex, and socio-economic/cultural status, and the low rate of early follow-up. Targeted interventions could be implemented to address specific groups and reduce croup-related ED visits.