{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:25:47Z","timestamp":1786116347019,"version":"build-2736575974"},"reference-count":21,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Introduction: Despite the availability of the national clinical practice guideline (CPG) for croup treatment, adherence has not been evaluated in real-world settings. This study aimed to evaluate adherence to the national CPG for croup and to identify factors associated with incomplete adherence. Method: Patients aged 1 month to 15 years diagnosed with viral croup between 1 January 2014 and 31 December 2023 were retrospectively reviewed. Complete adherence was defined as follows: (1) corticosteroid prescription for any severity, (2) nebulised epinephrine for moderate-to-severe cases, and (3) observation for \u22654 h for moderate-to-severe croup. Furthermore, associated factors for incomplete adherence and unplanned revisits within 72 h were explored. Results: A total of 437 visits were included; 71.2% were male patients, with a mean age of 25.6 \u00b1 19 months. Complete adherence increased from 46.7% in 2014 to 87.6% in 2023. Corticosteroid prescription showed the lowest adherence rates, particularly in mild cases. Factors associated with incomplete adherence by univariable analyses included the first croup episode (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.15\u20135.54), a paediatrician as the primary physician (OR, 2.61; 95% CI, 1.64\u20134.14), outpatient visits (OR, 2.36; 95% CI, 1.49\u20133.73), mild croup (OR, 1.89; 95% CI, 1.21\u20132.98), and earlier years of the study (OR, 2.41; 95% CI, 1.55\u20133.78). The unplanned revisit rate was 19.7% and was not associated with adherence. Conclusions: Adherence to the national guidelines increased over the past decade. However, suboptimal treatment practices underscore the need for targeted interventions to improve guideline-based care, particularly in paediatric and outpatient settings.<\/jats:p>","DOI":"10.3390\/children13081046","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:08:02Z","timestamp":1786003682000},"page":"1046","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Decade of Croup Management: Guideline Adherence, Practice Variation, and Opportunities for Improvement"],"prefix":"10.3390","volume":"13","author":[{"given":"Jirattikarn","family":"Jirawong","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8937-568X","authenticated-orcid":false,"given":"Wanaporn","family":"Anuntasaree","sequence":"additional","affiliation":[{"name":"Division of Pediatrics Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanokpan","family":"Ruangnapa","sequence":"additional","affiliation":[{"name":"Division of Pediatrics Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1936-3357","authenticated-orcid":false,"given":"Kantara","family":"Saelim","sequence":"additional","affiliation":[{"name":"Division of Pediatrics Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5618-0619","authenticated-orcid":false,"given":"Pharsai","family":"Prasertsan","sequence":"additional","affiliation":[{"name":"Division of Pediatrics Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1097\/INF.0b013e31829b7e43","article-title":"Viral etiologies of infant bronchiolitis, croup and upper respiratory illness during 4 consecutive years","volume":"32","author":"Miller","year":"2013","journal-title":"Pediatr. 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Rev., CD001955.","DOI":"10.1002\/14651858.CD001955.pub5"},{"key":"ref_5","first-page":"e46317","article-title":"An overview of the effectiveness of corticoids in croup: A systematic literature review","volume":"15","author":"Jaramillo","year":"2023","journal-title":"Cureus"},{"key":"ref_6","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","year":"2023","journal-title":"Hosp. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bjornson, C., Russell, K., Vandermeer, B., Klassen, T.P., and Johnson, D.W. (2013). Nebulized epinephrine for croup in children. Cochrane Database Syst. 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Care"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1046\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:52:16Z","timestamp":1786006336000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":21,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13081046"],"URL":"https:\/\/doi.org\/10.3390\/children13081046","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}