Bronchoscopy in Pediatric Recurrent Croup: How Many Need Surgery?

Introduction: This study evaluated bronchoscopy findings in children with recurrent croup (RC) and whether these findings led to surgical intervention. Operative management was used as a clinically relevant outcome to assess the impact of bronchoscopy in this population.

Methods: A single institution retrospective review of children undergoing bronchoscopy for RC (01/01/2019-1/20/2026) was performed. Age, sex, race, bronchoscopy findings, and further treatments required were noted. Bronchoscopy findings were classified as structural (further subdivided into subglottic and supraglottic abnormalities), inflammatory, and dynamic airway collapse. Group comparisons were conducted using Chi-square or Fisher’s exact tests and associations were evaluated using multivariable logistic regression.

Results: 110 children (mean age of 4.3 ± 2.7 years) had bronchoscopy for RC, 76 (69.1%) male and 34 (30.9%) female. Bronchoscopy findings were normal in 41 patients (37.3%). 69 (62.7%) had at least one abnormal finding, including inflammatory airway changes in 31 (28.2%), dynamic airway collapse in 24 (21.8%), fixed structural subglottic abnormalities in 23 (20.9%), and fixed structural supraglottic abnormalities in 16 (14.5%). Subglottic stenosis was the most common subglottic structural abnormality (N=11, 10%). Two (1.8%) patients with subglottic stenosis underwent balloon dilation. There were no other bronchoscopy-directed surgical interventions in the other 108 patients.
Children < 3 years were significantly more likely to have structural abnormalities than those ≥3 (46.2% vs 22.5%; χ² p=.01). Age-stratified analysis showed that children < 3 years were significantly more likely to have subglottic stenosis compared with children aged 3 or older (9/38 [23.7%] vs 2/72 [2.8%]; Fisher’s exact p=.001).

Conclusions: Bronchoscopy in children with RC infrequently identifies abnormalities requiring surgical intervention. These findings support a more selective approach to bronchoscopy, with careful consideration of its role in routine evaluation.