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Croup: Rapid Evidence Review
Alexandria Cooke1, Sara Conway2, Leslie Griffin3
1Erlanger Health, Chattanooga, Tennessee, and University of Tennessee Health Science Center (UTHSC) College of Medicine, Chattanooga.
Insights
Croup, a common childhood respiratory illness, causes barking cough and stridor due to upper airway inflammation. Corticosteroids like dexamethasone are the primary treatment, with nebulized epinephrine for severe cases.
Area of Science:
- Pediatrics
- Pulmonology
- Emergency Medicine
Background:
- Croup is a frequent pediatric respiratory condition characterized by subglottic inflammation.
- Symptoms include barking cough, hoarseness, and inspiratory stridor, often accompanied by fever.
- Differential diagnosis must exclude severe upper airway obstructions like epiglottitis or abscesses.
Purpose of the Study:
- To outline the diagnosis and management of croup in children.
- To emphasize the importance of differentiating croup from more critical conditions.
- To review current treatment guidelines for croup.
Main Methods:
- Clinical assessment for characteristic symptoms of croup.
- Consideration of differential diagnoses for upper airway obstruction.
- Review of treatment protocols including corticosteroids and nebulized epinephrine.
Main Results:
- Corticosteroids, particularly dexamethasone, are effective first-line treatments.
- Nebulized epinephrine is indicated for moderate to severe croup.
- Radiography and lab tests are generally not required unless the diagnosis is uncertain.
Conclusions:
- Prompt recognition and appropriate management of croup are essential.
- Corticosteroids reduce symptom severity and healthcare utilization.
- Recurrent croup warrants investigation for underlying abnormalities.
Abstract:
Croup is a common childhood respiratory illness with peak incidence in October and November. Inflammation of the subglottic structures results in obstruction of the upper airway, causing the characteristic barking cough, hoarseness, and inspiratory stridor. Fever may also be present. Patients with suspected croup should be assessed for more severe causes of upper airway obstruction, such as bacterial tracheitis, retropharyngeal abscess, peritonsillar abscess, foreign body obstruction, and epiglottitis. Radiography or laboratory testing is typically unnecessary for diagnosis but should be considered if the diagnosis is unclear. Corticosteroids are recommended as first-line treatment to reduce symptom burden and the need for advanced medical care. Dexamethasone is the most-studied corticosteroid, but prednisolone may also be used. A single oral dose of dexamethasone (0.6 mg/kg, maximum 12 mg) is standard. Moderate to severe croup should be treated with nebulized epinephrine and corticosteroids. Recurrent episodes of croup should prompt evaluation for an underlying anatomic abnormality or medical condition.
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