Care Variation Among Sites Participating in a National Quality Improvement Initiative for Croup.

Creator(s)

• Kelly R. Bergmann
• Vivian Lee
• Gabrielle Z Hester
• Ellen Kerns
• Makayla Schissel
• Kendall Arslanian
• Sloane Magee
• Brittany Jennings
• Bolanle Akinsola
• Beth Condley
• Amy M. DeLaroche
• Daniela Hochreiter
• Adolfo L. Molina
• Amanda Nedved, Children's Mercy HospitalFollow
• Lisa L. Schroeder, Children's Mercy HospitalFollow
• Ryan Sewell
• Randi Trope
• Amy Tyler
• Irina Topoz
• Better Assessment and Response to Croup in Kids (BARCK) Collaborative

Document Type

Article

Publication Date

8-2026

Identifier

DOI: 10.1542/hpeds.2025-009086

Abstract

BACKGROUND: There is substantial care variation for children with croup. Our primary aim was to describe variation in croup pathways by acute care setting and hospital type among sites participating in a national quality improvement (QI) collaborative-Better Assessment and Response to Croup in Kids (BARCK).

METHODS: We conducted a cross-sectional study, consisting of site surveys to identify site characteristics and an independent review of croup clinical pathways by study physicians. Site application surveys were distributed via the Pediatric Acute and Critical Care and Quality Network listserv in September 2024, and a preproject survey was distributed between January and February 2025. Data were reported using frequencies and percentages.

RESULTS: Of 107 participating sites, 96 (89.7%) completed surveys. Forty-eight (50.0%) sites indicated having a croup pathway, of which 30 (28.0% of participating sites, 62.5% with a croup pathway) were submitted and reviewed. Of 30 sites with croup pathways, 17 (56.7%) were classified as emergency departments (EDs) and 13 (43.3%) as mixed ED and urgent care (UC). Nine (52.9%) pathways from ED sites recommended ≥3 racemic epinephrine (RE) treatments before admission compared with 4 (30.8%) pathways from ED/UC sites. Few pathways from ED sites guided when to obtain a neck (23.5%) or chest radiograph (17.6%) compared with pathways from ED/UC sites (53.8% and 46.2%, respectively). Findings were similar when comparing by hospital type.

CONCLUSIONS: There is considerable variation in croup pathways. The BARCK collaborative will provide an opportunity to standardize care practices across care settings.

Journal Title

Hosp Pediatr

Volume

16

Issue

8

First Page

592

Last Page

600

MeSH Keywords

Croup; Humans; Quality Improvement; Cross-Sectional Studies; Critical Pathways; United States; Child; Emergency Service, Hospital

PubMed ID

42034383

Keywords

Croup; Quality Improvement; Cross-Sectional Studies; Critical Pathways; United States; Hospital Emergency Service

Recommended Citation

Bergmann KR, Lee V, Hester GZ, et al. Care Variation Among Sites Participating in a National Quality Improvement Initiative for Croup. Hosp Pediatr. 2026;16(8):e592-e600. doi:10.1542/hpeds.2025-009086