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Croup: assessment and evidence-based management
Dominic A Fitzgerald1, Henry A Kilham
1Department of Respiratory Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. dominif2@chw.edu.au
Insights
Systemic corticosteroids can effectively manage croup in children, reducing hospital admissions and intensive care unit stays. Early intervention in primary care or emergency departments improves outcomes for mild to severe cases.
Area of Science:
- Pediatrics
- Emergency Medicine
Background:
- Croup affects 2% of preschool children annually, with most cases being mild.
- Moderate to severe croup requires emergency department evaluation and potential hospitalization.
Purpose of the Study:
- To discuss the assessment and evidence-based management of childhood croup.
- To provide guidance for managing mild croup in general practice and moderate-to-severe croup in emergency departments.
Main Methods:
- Review of current literature on croup assessment and management.
- Development of a flowchart for emergency department croup treatment.
Main Results:
- Liberal use of systemic corticosteroids is linked to decreased hospital admissions, ICU admissions, and endotracheal intubations.
- Specific management strategies are outlined for mild and moderate-to-severe croup presentations.
Conclusions:
- Systemic corticosteroids are beneficial in reducing croup severity and healthcare utilization.
- Evidence-based guidelines can optimize the assessment and treatment of croup in pediatric patients.
Abstract:
Croup affects about 2% of preschool-aged children every year. Most children have mild croup and are managed at home, often after review by a general practitioner, who may decide that a single dose of oral corticosteroid is indicated (eg, if a risk factor for hospital admission exists). A minority of children develop moderate or severe croup. They should be reviewed in an emergency department and may need hospital admission. More liberal use of systemic corticosteroids for croup (in both primary care and emergency department settings) has been associated with reduced rates of hospital admission, reduced admissions to the intensive care unit and a reduced need for endotracheal intubation. We discuss the assessment and evidence-based management of a child with mild croup presenting to a GP and a child with moderately severe croup presenting to an emergency department. We present a flow chart summarising an approach to assessing and treating croup in the emergency department.
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