Predictors of Recurrent Croup: The Role of Social Determinants of Health and Otolaryngology Evaluation.

OBJECTIVE: To evaluate the influence of patient comorbidities, social determinants of health (SDOH), and otolaryngology (OTO) referral timing on disease course and healthcare utilization among pediatric patients with recurrent croup. STUDY DESIGN: Retrospective cohort study. SETTING: Large tertiary children's hospital. METHODS: Pediatric patients (0-18 years) evaluated by an OTO for recurrent croup between 2011 and 2024 were included (n = 70). Demographic, clinical, and referral data were obtained from medical records. SDOH were quantified using state-standardized Childhood Opportunity Index (COI) 3.0 scores across 3 domains and 14 subdomains. Associations between comorbidities, SDOH, and referral timing with disease duration, number of emergency department (ED) visits, corticosteroid prescriptions, and age at resolution were analyzed using t-tests and correlation coefficients (α = 0.05). RESULTS: Household tobacco exposure and gastroesophageal reflux disease were associated with earlier croup onset (P < .05). Higher Wealth, Health Resource, and Educational Resource scores correlated with shorter disease duration, fewer ED visits, and younger age at resolution (P < .05). Shorter intervals from first ED visit to OTO evaluation correlated with fewer ED visits (r = 0.28, P < .02), fewer corticosteroid prescriptions (r = 0.28, P < .02), and shorter disease duration (r = 0.51, P < .0001). CONCLUSION: Early otolaryngology involvement and favorable SDOH-particularly wealth, health, and educational resources-were associated with improved outcomes in recurrent croup. These findings highlight opportunities for targeted counseling, timely referral, and community-based interventions to reduce healthcare burden and enhance pediatric airway care. LEVEL OF EVIDENCE: III.