Assessing the adherence to guidelines in the management of croup in Australian children: A population-based sample survey

Bernadette Prentice*, Susan Moloney, Jason Hort, Peter Hibbert, Louise K. Wiles, Charlotte J. Molloy, Gaston Arnolda, Hsuen P. Ting, Jeffrey Braithwaite, Adam Jaffe

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

3 Citations (Scopus)


Objective: To determine the extent to which care received by Australian children presenting with croup is in agreement with Clinical Practice Guidelines (CPGs). 

Design: Retrospective population-based sample survey. Croup clinical indicators were derived from CPGs. 

Data sources/study setting: Medical records from three healthcare settings were sampled for selected visits in 2012 and 2013 in three Australian states. 

Data collection: Data were collected by nine experienced paediatric nurses, trained to assess eligibility for indicator assessment and adherence to CPGs. Surveyors undertook criterion-based medical record reviews using an electronic data collection tool. 

Results: Documented guideline adherence was lower for general practitioners (65.9%; 95% CI: 60.8–70.6) than emergency departments (91.1%; 95% CI: 89.5–92.5) and inpatient admissions (91.3%; 95% CI: 88.1–93.9). Overall adherence was very low for a bundle of 10 indicators related to assessment (4.5%; 95% CI: 2.4–7.6) but higher for a bundle of four indicators relating to the avoidance of inappropriate therapy (83.1%; 95% CI: 59.5–96.0). Conclusions: Most visits for croup were characterized by appropriate treatment in all healthcare settings. However, most children had limited documented clinical assessments, and some had unnecessary tests or inappropriate therapy, which has potential quality and cost implications. Universal CPG and clinical assessment tools may increase clinical consistency.

Original languageEnglish
Pages (from-to)759-767
Number of pages9
JournalInternational Journal for Quality in Health Care
Issue number10
Publication statusPublished - 1 Dec 2019


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