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Dexamethasone regime and clinical outcomes in children hospitalized with croup: A cohort study
David D'Arienzo1,2,3, Muhammadhasan Nasser4, Peter J Gill2,3,4,5,6,7
1Department of Paediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
Insights
For hospitalized children with croup, receiving more than one dose of dexamethasone led to longer hospital stays but did not increase 30-day emergency department visits. Further research is needed for optimal inpatient croup treatment.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Clinical Trial Design
Background:
- Outpatient croup management utilizes one dose of dexamethasone effectively.
- Inpatient croup treatment lacks robust trial evidence, leading to practice variability.
- Optimal corticosteroid regimens for hospitalized croup patients remain undetermined.
Purpose of the Study:
- To compare single-dose versus multi-dose dexamethasone regimens in hospitalized croup patients.
- To assess the impact of dexamethasone dosing on hospital length of stay (LOS).
- To evaluate the association between dexamethasone regimen and 30-day emergency department (ED) return visits.
Main Methods:
- Retrospective cohort study of 471 children hospitalized for croup (2010-2022).
- Comparison of children receiving one dose versus more than one dose of dexamethasone.
- Propensity score weighting used to analyze effects on LOS and 30-day ED return.
Main Results:
- Children receiving >1 dose of dexamethasone had a significantly longer mean LOS (59.6 hours longer).
- No significant difference was observed in all-cause 30-day return to ED visits between groups.
- 49% of patients received one dose, while 51% received >1 dose of dexamethasone.
Conclusions:
- Multiple doses of dexamethasone in hospitalized croup patients correlate with increased hospital length of stay.
- Dexamethasone dosing strategy did not significantly affect 30-day ED return rates.
- Randomized controlled trials are essential to establish the optimal dexamethasone regimen for inpatient croup.
Background:
High-quality trial evidence supports the use of one dose of dexamethasone in the outpatient management of croup; however, there are no inpatient trials, and the optimal treatment regimen for the inpatient management of croup remains uncertain. Significant practice variability exists in the corticosteroid treatment of children hospitalized for croup.
Objective:
To evaluate the association of dexamethasone treatment regimen (1 vs. >1 dose) with hospital length of stay (LOS) and 30-day return to emergency department (ED) visits among children hospitalized for croup.
Methods:
A cohort study of children hospitalized for croup at a children's hospital between 2010 and 2022. Children less than 10 years old, without known airway anomalies and who received dexamethasone for croup treatment were included. Children who received 1 dose versus >1 dose of dexamethasone were compared. Propensity score analyses, using inverse probability of treatment weighting, were conducted to estimate the treatment effects of dexamethasone regimen on hospital LOS and all-cause 30-day return to ED visit.
Results:
Of 471 children hospitalized for croup, 229 (49%) received 1 dose of dexamethasone; 242 (51%) received >1 dose. In the propensity-weighted analyses, children receiving >1 dose of dexamethasone had a longer mean LOS by 59.6 h (95% CI 44.8-74.5, p < .001) compared with those receiving >1 dose. There was no statistically significant difference in the odds of all-cause 30-day return to ED visit; OR 1.30, (95% CI 0.76-2.22, p = .33).
Conclusions:
Among children hospitalized for croup, children who received >1 dose of dexamethasone had a longer LOS compared with children who received 1 dose of dexamethasone; however, there was no statistically significant difference in the 30-day return to ED visits. Randomized clinical trials are needed to determine the optimal dexamethasone treatment regimen for children hospitalized with croup.
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