Viral laryngotracheobronchitis is a ubiquitous infectious process that has not caused significant mortality in the past 20 years. Bacterial tracheitis and pneumonia can complicate viral laryngotracheobronchitis and markedly increase the risk of bad outcome. Even uncomplicated, properly managed, viral laryngotracheobronchitis can occasionally result in death, particularly in the infant age group.
Viral laryngotracheobronchitis, or croup, is a common presentation in the pediatric emergency department. The course is generally benign and self-limited. 1 Earlier this century and well into the 1960s, mortality from croup was reported to be significant. 2 In the modern era, children with croup are managed as outpatients in the large majority of cases. Patients with inspiratory stridor at rest or respiratory distress are typically admitted for observation, although the need for intubation currently occurs in less than 1 percent of hospitalized patients. 3
Outpatients with croup routinely receive glucocorticoid therapy, which has been demonstrated to lower admission rates and ameliorate symptoms. 4-6 Over the past decade, the mortality from viral laryngotracheobronchitis has been low, and even the mortality of its most feared complication, bacterial tracheitis, has decreased dramatically in recent years. 7,8 We report 2 out-of-hospital deaths in young children with croup. Each child had been recently seen by an experienced pediatrician, diagnosed with viral croup, and managed with outpatient glucocorticoids. The cases emphasize the need for careful assessment and close follow-up of patients with croup.