Hospital Course of Croup After Emergency Department Management

Area of Science:

• Pediatric Emergency Medicine
• Respiratory Illness Management

Background:

• Croup is a common pediatric respiratory illness often managed in emergency departments.
• Inpatient management strategies for croup vary, impacting resource utilization and patient outcomes.

Purpose of the Study:

• To characterize the inpatient management of pediatric patients diagnosed with croup and admitted from the emergency department.
• To identify factors associated with the need for significant interventions during hospitalization for croup.

Main Methods:

• A multicentered, cross-sectional observational study utilizing retrospective chart review.
• Included children aged 6 months to 5 years with a croup diagnosis, evaluated in the ED and treated with racemic epinephrine (RE) prior to admission.
• Excluded patients with hypoxia or direct Pediatric Intensive Care Unit (PICU) admission.

Main Results:

• Of 628 croup admissions, 22.6% received significant interventions (additional RE or PICU transfer).
• The majority (77.4%) of patients did not require significant interventions, with an average length of stay under 24 hours.
• Tachypnea on ED arrival (OR 2.5) and use of ED radiographs (OR 1.7) were associated with increased odds of post-admission interventions.

Conclusions:

• Less than a quarter of admitted croup patients require significant inpatient interventions.
• Emergency department findings like tachypnea and radiography use can predict the need for further interventions in croup management.