{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:50:00Z","timestamp":1791885000678,"version":"4.3.4"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To determine predictors of ENT referral and microlaryngobronchoscopy (MLB) findings in children with recurrent croup.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Large district general NHS trust (2013\u20132023).<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Children <\u200918\u2009years with \u2265\u20092 croup episodes in 12\u2009months or a clinician diagnosis of recurrent croup.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n ENT referral, MLB performance and abnormal MLB findings.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 128 children met recurrent croup criteria (median age 13.5\u2009months, median 5 episodes). Sixty\u2010two (48%) were referred to ENT, of which 34 (55%) underwent MLB. Thirteen (38%) MLBs were normal. Abnormalities included subglottic stenosis (\n n<\/jats:italic>\n \u2009=\u20095), dynamic airway collapse (\n n<\/jats:italic>\n \u2009=\u20094), vocal\u2010cord pathology (\n n<\/jats:italic>\n \u2009=\u20093), non\u2010specific inflammatory\/irritative change (\n n<\/jats:italic>\n \u2009=\u20093) and subglottic lesions (\n n<\/jats:italic>\n \u2009=\u20095), with the latter requiring surgical excision. Referred children were younger (median 12 vs. 17\u2009months,\n p<\/jats:italic>\n \u2009=\u20090.038) and had more episodes (median 5.5 vs. 4.0,\n p<\/jats:italic>\n \u2009=\u20090.013). ENT referral correlated with ENT\u2010related conditions (26%,\n p<\/jats:italic>\n \u2009<\u20090.001), gastro\u2010oesophageal reflux (24%,\n p<\/jats:italic>\n \u2009=\u20090.021) and recurrent viral infections (47%,\n p<\/jats:italic>\n \u2009=\u20090.022). MLB was more common with ENT\u2010related conditions (38%,\n p<\/jats:italic>\n \u2009<\u20090.001) and reflux (32%,\n p<\/jats:italic>\n \u2009=\u20090.003). After adjustment, only episode count predicted ENT referral (aOR 1.09 per episode, 95% CI: 1.01\u20131.19), no factor predicted MLB or abnormal findings.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n ENT review is warranted for recurrent croup, whereas MLB should be reserved for children with red\u2010flag features suggesting significant airway pathology. Although most scoped children had normal or conservatively managed findings, a meaningful minority had clinically important abnormalities, including subglottic lesions requiring surgical intervention. Conventional risk factors offer little predictive value, supporting prospective multi\u2010centre studies to refine risk\u2010stratification.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/coa.70178","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:42:28Z","timestamp":1791884548000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of\n ENT<\/scp>\n Referral and Microlaryngobronchoscopy Findings in Children With Recurrent Croup: A 10\u2010Year Cohort Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8836-2863","authenticated-orcid":false,"given":"Noon","family":"Nassr","sequence":"first","affiliation":[{"name":"Mid Yorkshire Teaching Trust Pinderfields Hospital Wakefield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Wareing","sequence":"additional","affiliation":[{"name":"Mid Yorkshire Teaching Trust Pinderfields Hospital Wakefield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Ward","sequence":"additional","affiliation":[{"name":"Mid Yorkshire Teaching Trust Pinderfields Hospital Wakefield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/S0140-6736(08)60170-1","article-title":"Croup","volume":"371","author":"Bjornson C. L.","year":"2008","journal-title":"Lancet"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1002\/ppul.21162","article-title":"Croup Presentations to Emergency Departments in Alberta, Canada: A Large Population\u2010Based Study","volume":"45","author":"Rosychuk R. J.","year":"2010","journal-title":"Pediatric Pulmonology"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ijporl.2016.09.003","article-title":"Bronchoscopy Findings in Recurrent Croup: A Systematic Review and Meta\u2010Analysis","volume":"90","author":"Hiebert J. C.","year":"2016","journal-title":"International Journal of Pediatric Otorhinolaryngology"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijporl.2018.09.004","article-title":"Use of the Pediatric Intensive Care Unit for Post\u2010Procedural Monitoring in Young Children Following Microlaryngobronchoscopy: Impact on Resource Utilization and Hospital Cost","volume":"115","author":"Kerris E. J.","year":"2018","journal-title":"International Journal of Pediatric Otorhinolaryngology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"e241","DOI":"10.1542\/hpeds.2023-007221","article-title":"Variation in Organizational Clinical Practice Guidelines for Croup","volume":"13","author":"Bergmann K. R.","year":"2023","journal-title":"Hospital Pediatrics"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1017\/S0022215113000418","article-title":"The Management of Recurrent Croup in Children","volume":"127","author":"Rankin I.","year":"2013","journal-title":"Journal of Laryngology and Otology"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1136\/archdischild-2013-303846","article-title":"Fifteen\u2010Minute Consultation: Structured Approach to Management of a Child With Recurrent Croup","volume":"99","author":"Joshi V.","year":"2014","journal-title":"Archives of Disease in Childhood. Education and Practice Edition"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1159\/000547196","article-title":"Airway Endoscopy Findings in Children With Recurrent Croup","volume":"87","author":"Tong J. Y.","year":"2025","journal-title":"ORL; Journal for Oto\u2010Rhino\u2010Laryngology and Its Related Specialties"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1177\/01455613231170087","article-title":"Recurrent Croup Is a Good Indicator of Underlying Paediatric Airway Issues: A 10\u2010Year Retrospective Cohort Study of Airway Endoscopy","volume":"104","author":"Hampton T.","year":"2025","journal-title":"Ear, Nose, & Throat Journal"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/00034894241312100","article-title":"Aerodigestive Approach in Evaluating Pediatric Patients With Recurrent Croup","volume":"134","author":"Chen X.","year":"2025","journal-title":"Annals of Otology, Rhinology, and Laryngology"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.anl.2023.07.005","article-title":"Triple Endoscopy and Recurrent Croup in Children: A Single Aerodigestive Center Experience","volume":"51","author":"Vu J. P.","year":"2024","journal-title":"Auris, Nasus, Larynx"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.amjoto.2006.11.013","article-title":"Recurrent Croup Presentation, Diagnosis, and Management","volume":"28","author":"Kwong K.","year":"2007","journal-title":"American Journal of Otolaryngology"},{"key":"e_1_2_11_14_1","volume-title":"International Statistical Classification of Diseases and Related Health Problems","year":"2011"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1542\/peds.71.6.871","article-title":"Croup: An 11\u2010Year Study in a Pediatric Practice","volume":"71","author":"Denny F. W.","year":"1983","journal-title":"Pediatrics"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"Elm E.","year":"2007","journal-title":"Lancet"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1016\/j.ijporl.2015.10.039","article-title":"Objective Endoscopic Findings in Patients With Recurrent Croup: 10\u2010Year Retrospective Analysis","volume":"79","author":"Hodnett B. L.","year":"2015","journal-title":"International Journal of Pediatric Otorhinolaryngology"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/ppul.23957","article-title":"Complications and Risk Factors in Pediatric Bronchoscopy in a Tertiary Pediatric Respiratory Center","volume":"53","author":"Carlens J.","year":"2018","journal-title":"Pediatric Pulmonology"},{"key":"e_1_2_11_19_1","first-page":"575","article-title":"Croup: Diagnosis and Management","volume":"97","author":"Smith D. K.","year":"2018","journal-title":"American Family Physician"}],"container-title":["Clinical Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70178","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/coa.70178","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70178","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:42:31Z","timestamp":1791884551000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/coa.70178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":18,"alternative-id":["10.1111\/coa.70178"],"URL":"https:\/\/doi.org\/10.1111\/coa.70178","archive":["Portico"],"relation":{},"ISSN":["1749-4478","1749-4486"],"issn-type":[{"value":"1749-4478","type":"print"},{"value":"1749-4486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"2025-10-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"coa.70178"}}