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

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 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 pre-project 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 prior to admission compared to 4 (30.8%) pathways from ED/UC sites. Few pathways from ED sites provided guidance on when to obtain a neck (23.5%) or chest radiograph (17.6%) compared to 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.