Related Experiment Video
Updated: Jan 21, 2026
Assessing Working Memory in Children: The Comprehensive Assessment Battery for Children – Working Memory (CABC-WM)
Published on: June 12, 2017
Inpatient use of racemic epinephrine for children admitted with croup
Elaine Chiang1,2, Omar Afandi3,2, Sang Hoon Lee4,5
1Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Pediatric croup patients needing more than two racemic epinephrine (RE) doses in the hospital were more likely to have recently used steroids. Most of these patients require additional RE within 8-12 hours of admission.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Pharmacology
Background:
- Croup is a common pediatric respiratory illness.
- Hospital admission for croup is often indicated by the need for multiple racemic epinephrine (RE) doses in the emergency department (ED).
- Identifying predictors for increased RE use can optimize patient management.
Purpose of the Study:
- To determine factors associated with requiring more than two doses of racemic epinephrine (RE) during hospitalization for croup.
- To analyze the timing of additional RE doses and 72-hour return visits.
Main Methods:
- A single-center retrospective study included pediatric patients admitted with croup from 2011-2015.
- Logistic regression identified factors associated with >2 RE doses.
- Survival analysis assessed time to the third RE dose.
Main Results:
- 30% of admitted croup patients required >2 RE doses.
- Recent steroid use within 24 hours prior to presentation was significantly associated with needing >2 RE doses (P=0.007).
- The majority of patients requiring a third RE dose did so within 8-12 hours.
Conclusions:
- Recent pre-hospital steroid use is a predictor for increased racemic epinephrine (RE) requirement in hospitalized croup patients.
- The timing of additional RE administration is concentrated within the first 8-12 hours of hospitalization.
- These findings aid in risk stratification and determining monitoring duration for croup admissions.
Background:
Pediatric patients with croup are frequently admitted if they require two doses of racemic epinephrine (RE) in the emergency department (ED). We aimed to identify factors associated with the need for additional therapy (> 2 RE doses) among pediatric patients with croup.
Methods:
We performed a single-center retrospective study of consecutive patients admitted from the ED with a diagnosis of croup between January 1, 2011 and December 31, 2015. Primary outcome was need for > 2 doses of RE. Secondary outcomes included time to third RE and 72-hour return visits. We performed logistic regression to identify factors associated with use of > 2 RE doses during hospitalization, and survival analysis to identify time to dosing of 3rd RE from 2nd RE.
Results:
Of 353 included admissions [250 (70.8%) males, median age 1.48, interquartile range 0.97-2.51 years], 106/353 (30.0%) required > 2 RE. In univariate logistic regression, only recent use of steroids within 1 day prior to presentation (4.18, 1.48-11.83; P = 0.007) was associated with need for > 2 RE. Survival from third RE was 0.74 (95% CI 0.69-0.78), which was similar to the survival at 12 hours (0.70, 95% CI 0.65-0.75). Return visits occurred in 19 (5.4%) patients, of whom 12/19 (63.2%) were given RE.
Conclusions:
Patients hospitalized for croup with recent use of steroids prior to ED presentation have a greater need for > 2 RE during hospitalization. The majority who require inpatient RE will do so within 8-12 hours. These data provide information for risk stratification and duration of monitoring for patients hospitalized with croup.
Related Concept Videos
02:30Racemic Mixtures and the Resolution of Enantiomers
01:29Drug Dosing: Infants and Children
01:37Hypothalamic-Pituitary Axis
01:54Attitudes
01:25The Sympathetic Nervous System
02:13Types of Hormones