الفهرس 
Introduction
Aim of workOnly 14 pages are availabe for public view
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Abstract
This audit study was done to measure the appropriateness of the steps of management of children with croup attending Assiut University children Hospital that did take place in a period of 6 months from the start of October 2017 to the end of March 2018 , against the set international guidelines. This study included 170 cases with croup.
Croup, or laryngotracheobronchitis, is a common childhood upper airway disorder caused by a viral infection resulting in inflammation in the upper airway. This inflammation results in the classic symptoms of: barking cough, stridor, hoarse voice, and respiratory distress. Croup is an acute respiratory illness that commonly affects preschool children.Severe episodes requiring hospital admission occur in around 5 per cent of cases, the majority of children have a mild, self-limiting illness, which can be safely managed at home.
Our study showed that detailed history was recorded and clinical manifestations were accurately reported as recommended in international guidelines.
Chest xـray was not done in thevast majority of the studied cases150 cases (88.2%) and was not recommended in all these cases. In seven cases (4.1%) chest x-ray wasn’t done and recommended due to doubt of alternative diagnosis (age <6months or >6 years or due to recurrence >3 episodes in one year),while was done and was recommended in seven cases (4.1%) due to doubt of alternative diagnosis (age <6months or >6 yearsor due to recurrence >3 episodes in one year) and show no abnormalities in all seven cases but was done and not recommended in six cases (3.5%). Arterial blood gases was done in one case of croup (0.6%) that was assessed as case with impending respiratory failure and show decreased oxygen saturation (O2 sat. 83%).
The assessment of cases showed that 63 (37.1%) cases were mild, 80 cases (47.1%) were moderate, 26 cases (15.3%) were severe and one case (0.6%) had impending respiratory failure. Oxygen inhalation was done only in 27cases (15.9%) including 26 cases having severe croup and the one case with impending respiratory failure.The antipyretics wereused in 139cases (81.8%) and recommended in all these cases who were feverish to provide more comfort. Antitussives were not used and not recommended in all cases as croup is adisease of upper air ways.Antibiotics were used only in 28 cases (16.5%) and not recommended in all these cases as croup is due to viral infection.
Dexamethasone (0.16ـ0.6mg /kg, I.M& I.V) once only was used in acute management in 8 cases (12.7%) of the mild cases but the rest of cases were managed against the international guidelines. Dexamethasone (0.16ـ0.6mg/kg, I.M & I.V) + nebulized adrenaline were used in acute management of 24 (30%) of the moderate cases and recommended in all these casesbut the rest of cases were managed against the international guidelines. Dexamethasone (0.16ـ0.6mg/kg, I.M & I.V) + nebulized adrenaline were used in acute management of seven (26.9%) of the severe cases and recommended in all these cases but the rest of cases were managed against the international guidelines.
Repeating of L.adrenaline / 20 minutes if required and waiting 2hrs after adrenaline intake were not done in any of the moderate or severe cases or the cases with impending respiratory failure and were recommended in all these cases. Budesonide inhalation (2mg) instead of dexamethasone (I.M & I.V) was not used in any of the severe cases and the cases with impending respiratory failure and was recommended in all these cases .
Direct hospitalization without any acute management was done in 18 cases(10.6%) (11moderate cases, six severe cases and one cases with impending respiratory failure ) and was not recommended in all these cases. Hospitalization was done in 28 cases (16.4%) { recommended in nine cases (32.1%) of these cases, not surely recommended in19 cases (67.9%) and not recommended in any case } and not done in 152 cases (83.6%) { recommended in seven cases of these cases (4.9%), not surely recommended in72 cases ( 50.7) and not recommended in 63 case (44.4%) }. Pediatric intensive care unit (PICU ) admission was done in four severe cases and the case with impending respiratory failure and not surely recommended due to un correct acute management or direct admission without acute management.