Skip to main content
Top
Published in: World Journal of Pediatrics 6/2019

01-12-2019 | Croup | Original Article

Inpatient use of racemic epinephrine for children admitted with croup

Authors: Elaine Chiang, Omar Afandi, Sang Hoon Lee, Srinivasan Suresh, Raymond D. Pitetti, Sriram Ramgopal

Published in: World Journal of Pediatrics | Issue 6/2019

Login to get access

Abstract

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.
Literature
1.
go back to reference Segal AO, Crighton EJ, Moineddin R, Mamdani M, Upshur RE. Croup hospitalizations in Ontario: a 14-year time-series analysis. Pediatrics. 2005;116:51–5.CrossRef Segal AO, Crighton EJ, Moineddin R, Mamdani M, Upshur RE. Croup hospitalizations in Ontario: a 14-year time-series analysis. Pediatrics. 2005;116:51–5.CrossRef
3.
go back to reference Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, et al. Glucocorticoids for croup in children. Cochrane Database Syst Rev. 2018;8:CD001955.PubMed Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, et al. Glucocorticoids for croup in children. Cochrane Database Syst Rev. 2018;8:CD001955.PubMed
8.
go back to reference Narayanan S, Funkhouser E. Inpatient hospitalizations for croup. Hosp Pediatr. 2014;4:88–92.CrossRef Narayanan S, Funkhouser E. Inpatient hospitalizations for croup. Hosp Pediatr. 2014;4:88–92.CrossRef
9.
go back to reference Delany DR, Johnston DR. Role of direct laryngoscopy and bronchoscopy in recurrent croup. Otolaryngol Head Neck Surg. 2015;152:159–64.CrossRef Delany DR, Johnston DR. Role of direct laryngoscopy and bronchoscopy in recurrent croup. Otolaryngol Head Neck Surg. 2015;152:159–64.CrossRef
10.
go back to reference Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH. Croup presentations to emergency departments in Alberta, Canada: a large population-based study. Pediatr Pulmonol. 2010;45:83–91.CrossRef Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH. Croup presentations to emergency departments in Alberta, Canada: a large population-based study. Pediatr Pulmonol. 2010;45:83–91.CrossRef
11.
go back to reference Cooper T, Kuruvilla G, Persad R, El-Hakim H. Atypical croup: association with airway lesions, atopy, and esophagitis. Otolaryngol Head Neck Surg. 2012;147:209–14.CrossRef Cooper T, Kuruvilla G, Persad R, El-Hakim H. Atypical croup: association with airway lesions, atopy, and esophagitis. Otolaryngol Head Neck Surg. 2012;147:209–14.CrossRef
12.
go back to reference Chameides L, Ralston M, American Academy of Pediatrics, American Heart Association. Pediatric advanced life support: provider manual. Dallas: American Heart Association; 2011. Chameides L, Ralston M, American Academy of Pediatrics, American Heart Association. Pediatric advanced life support: provider manual. Dallas: American Heart Association; 2011.
13.
go back to reference Bjornson CL, Klassen TP, Williamson J, Brant R, Mitton C, Plint A, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004;351:1306–13.CrossRef Bjornson CL, Klassen TP, Williamson J, Brant R, Mitton C, Plint A, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004;351:1306–13.CrossRef
14.
go back to reference Klassen TP. Effectiveness of glucocorticoids in treating croup authors acknowledge cochrane collaboration. BMJ. 1999;319:1577.CrossRef Klassen TP. Effectiveness of glucocorticoids in treating croup authors acknowledge cochrane collaboration. BMJ. 1999;319:1577.CrossRef
15.
go back to reference Chan PW. Risk factors associated with severe viral croup in hospitalised Malaysian children. Singap Med J. 2002;43:124–7. Chan PW. Risk factors associated with severe viral croup in hospitalised Malaysian children. Singap Med J. 2002;43:124–7.
Metadata
Title
Inpatient use of racemic epinephrine for children admitted with croup
Authors
Elaine Chiang
Omar Afandi
Sang Hoon Lee
Srinivasan Suresh
Raymond D. Pitetti
Sriram Ramgopal
Publication date
01-12-2019
Publisher
Springer Singapore
Keyword
Croup
Published in
World Journal of Pediatrics / Issue 6/2019
Print ISSN: 1708-8569
Electronic ISSN: 1867-0687
DOI
https://doi.org/10.1007/s12519-019-00291-x

Other articles of this Issue 6/2019

World Journal of Pediatrics 6/2019 Go to the issue