Racemic epinephrine use in croup and disposition

The purpose of this study was to determine the effectiveness of a protocol for the outpatient management of laryngotracheitis (croup) using racemic epinephrine and steroids. The authors retrospectively reviewed fifty consecutive charts of children with croup who were treated under this protocol in the Scottish Rite Children's Medical Center Emergency Department (Atlanta, GA) and discharged to home after 2 hours of observation. Forty-seven of the 50 children had stridor at rest and/or retracting at rest on presentation to the emergency department. Forty-seven of the 50 patients did not require further medical care within 48 hours. One patient required another emergency visit and additional treatment with racemic epinephrine. Two patients were lost to follow-up. This study suggests that selected children presenting with croup and significant distress may be effectively treated with racemic epinephrine and steroids, observed for at least 2 hours, and safely discharged home.