Related Experiment Videos
Outpatient treatment of croup with nebulized dexamethasone
D W Johnson1, S Schuh, G Koren
1Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Nebulized dexamethasone improved croup symptoms in children within 4 hours but did not significantly reduce hospitalizations. Researchers do not recommend this treatment due to potential complications and lack of sustained clinical effect.
Area of Science:
- Pediatrics
- Emergency Medicine
- Pharmacology
Background:
- Croup is a common respiratory illness in children.
- Acute, moderate croup often requires emergency department visits.
- Treatment options aim to alleviate symptoms and prevent hospitalization.
Purpose of the Study:
- To evaluate the efficacy of nebulized dexamethasone sodium phosphate in treating acute, moderate croup in children.
- To assess clinical improvement at 4 hours post-treatment.
- To determine if the treatment reduces hospitalization rates.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted.
- Fifty-five children with moderate croup were included.
- Clinical assessments included croup score, respiratory rate, heart rate, and oxygen saturation.
Main Results:
- Dexamethasone treatment led to significant clinical improvement in croup scores by 4 hours (P=.005).
- Hospitalization rates were not statistically different between the dexamethasone and placebo groups.
- Two cases of potential bacterial tracheitis were noted in the dexamethasone group.
Conclusions:
- Nebulized dexamethasone provides short-term clinical improvement for moderate croup.
- The study did not demonstrate a reduction in hospitalization rates.
- Due to infectious complications and lack of sustained effect, nebulized dexamethasone is not recommended for croup.
Purpose:
To determine if treating children who have acute, moderate croup with nebulized dexamethasone sodium phosphate in the emergency department results in clinical improvement by 4 hours and a decrease in the hospitalization rate.
Design:
Randomized, double-blind, placebo controlled trial.
Setting:
Emergency department, children's hospital.
Patients:
Fifty-five children with croup who were in moderate respiratory distress after treatment with mist for 30 minutes who met inclusion and exclusion criteria.
Measurements:
Croup score, respiratory rate, heart rate, and oxygen saturation were assessed by one of us (D.W.J. or S.S.) before treatment and 2 and 4 hours after treatment. A staff pediatrician or senior pediatric resident, also "blind" to treatment, decided on admission to or discharge from the hospital. The differences between groups for change in croup score and hospitalization rate after treatment were analyzed.
Results:
Evaluation of the croup scores disclosed a significant improvement in the dexamethasone-treated group compared with the placebo group at 4 hours (P=.005, Mann-Whitney U). However, the hospitalization rate was not statistically different at the end of treatment (33% vs 52%, P=.28) or after 24 hours (48% vs 60%, P=.56, Yates corrected chi(2)). Our study has 80% power to detect a two-thirds reduction in hospitalization rate. Two patients with neutropenia treated with dexamethasone had a clinical course consistent with bacterial tracheitis.
Conclusions:
Treatment of moderate croup with nebulized dexamethasone results in clinical improvement within 4 hours. We did not show a decrease in hospitalization rates, although our sample size was only large enough to detect a 67% reduction in the rate of hospitalization. Given the infectious complications and the absence of evidence for a sustained clinical effect, we do not recommend that patients with croup be treated with nebulized dexamethasone.