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Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department.

Sherri L Rudinsky1, Ghazala Q Sharieff2, Whitney Law3

  • 1Division of Emergency Medicine, Rady Children's Hospital San Diego, San Diego, California; Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.

The Journal of Emergency Medicine
|August 6, 2015
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Summary

Most children hospitalized for croup after two racemic epinephrine (RE) doses in the emergency department (ED) do not require significant inpatient treatment. Asymptomatic patients, in particular, often need minimal or no further RE, suggesting potential for outpatient management.

Keywords:
adverse reactioncroupdrug-related side effectsracepinephrine

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Area of Science:

  • Pediatric Emergency Medicine
  • Respiratory Illnesses
  • Clinical Interventions

Background:

  • Discharge from the emergency department (ED) is safe for croup patients once stridor resolves after corticosteroids and one dose of racemic epinephrine (RE).
  • Limited evidence supports hospital admission for croup patients receiving two or more doses of RE in the ED.

Purpose of the Study:

  • To determine the frequency and timing of significant inpatient interventions for croup patients admitted after receiving at least two doses of RE in the ED.
  • To compare intervention rates and outcomes between asymptomatic and symptomatic patients admitted after ED RE treatment.

Main Methods:

  • Retrospective study of 200 patients hospitalized for croup after receiving corticosteroids and ≥2 doses of RE in the ED.
  • Comparison of inpatient RE, heliox, supplemental oxygen, intubation, and transfer rates between asymptomatic and symptomatic groups.
  • Analysis of time to hospital discharge and 48-hour revisit/readmission rates.

Main Results:

  • 36% of admitted patients received clinically important inpatient interventions, most commonly RE (34%).
  • Asymptomatic patients required fewer interventions (14% vs. 63%) and had shorter hospital stays (14.5 vs. 22 hours) compared to symptomatic patients.
  • No intubations or transfers occurred; revisit and readmission rates were similar between groups.

Conclusions:

  • Inpatient interventions after multiple ED RE doses for croup are infrequent, with RE being the most common.
  • Asymptomatic patients admitted after ≥2 ED RE doses often require minimal further treatment and may be suitable for outpatient management.