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How long does stridor at rest persist in croup after the administration of oral prednisolone?
Robyn Parker1, Colin V Powell, Anne-Maree Kelly
1Department of Emergency Medicine, Northern Hospital, Cardiff, UK.
Insights
Oral steroids effectively treat stridor at rest (SAR) in children with croup, with most cases resolving promptly. This finding suggests some children may be treatable and discharged directly from the emergency department (ED).
Area of Science:
- Pediatrics
- Emergency Medicine
- Pharmacology
Background:
- Croup is a common pediatric respiratory illness often managed with corticosteroids.
- Stridor at rest (SAR) is a key symptom indicating croup severity.
- Current management often involves hospital admission for observation and treatment.
Purpose of the Study:
- To evaluate the duration of stridor at rest (SAR) following oral prednisolone administration in hospitalized croup patients.
- To investigate if mild croup cases experience faster SAR resolution after steroid treatment.
Main Methods:
- Retrospective chart review of 188 children admitted with croup over one year.
- Data included patient demographics, croup severity scores (Westley and Geelhoed), and SAR duration post-steroids.
- Analysis focused on SAR duration and its correlation with initial croup severity.
Main Results:
- The median duration of SAR was 6.5 hours (range 0.5-82 hours).
- Children with lower Westley (< or = 2) or Geelhoed (< or = 3) scores had slightly shorter SAR durations (6 vs. 7 hours, P < 0.05).
- This difference, while statistically significant, was deemed clinically insignificant.
Conclusions:
- Oral steroids lead to prompt resolution of stridor at rest in most pediatric croup cases.
- A subset of croup patients may be suitable for emergency department (ED) treatment and discharge, avoiding hospitalization.
Objectives:
To determine the duration of stridor at rest (SAR) after the administration of oral prednisolone (1 mg/kg) to children admitted to hospital with croup from the ED. The secondary objective was to determine whether children with mild croup had a more rapid resolution of SAR.
Methods:
This was a retrospective explicit chart review of all children admitted to the paediatric ward of a community, paediatric teaching hospital with a diagnosis of croup over one year. Data collected included patient demographics, Westley and Geelhoed croup scores on presentation to the ED and the duration of SAR after administration of steroids.
Results:
For the 188 cases analyzed, median duration of SAR was 6.5 h (95% CI 6-7 h, range 0.5-82 h). Children with a Westley score of < or = 2 or a Geelhoed score of < or = 3 had a shorter duration of SAR than those with higher scores (6 h vs. 7 h, P < 0.05), which although statistically significant is unlikely to be of clinical significance.
Conclusions:
Stridor at rest resolves promptly after the administration of oral steroids in the vast majority of cases. This suggests that a subset of patients previously admitted to hospital with croup may be able to be treated and discharged from the ED.
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