Hospital Course of Croup After Emergency Department Management

Asmundsson, Anna Sofi; Arms, Joseph; Kaila, Rahul; Roback, Mark G.; Theiler, Carly A.; Davey, Cynthia; Louie, Jeffrey P.

doi:10.1542/hpeds.2018-0066

Cited by 15 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While this case series is limited to only three patients, all had ≥3 total NRE treatments, dexamethasone, and additional inpatient interventions (i.e., additional NRE, BiPAP, or heliox). Inpatient interventions for croup are relatively infrequent (22.6% in one study), suggesting potentially more severe pathophysiology with COVID-19 croup versus previously described croup [ 15 ]. Pediatric croup patients who received ≥3 NRE in one children's hospital were more likely to need intensive care management [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric croup with COVID-19

Venn

Schmidt

Mullan

2021

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. Each received multiple (≥3) doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. All had a prolonged period of time from ED presentation until the resolution of their stridor at rest (13, 19, and 21 h). All received dexamethasone early in their ED treatment and all were admitted. All three received at least one additional dose of dexamethasone, an atypical treatment occurrence in our hospital, due to each patient's prolonged duration of symptoms. One child required heliox therapy and admission to intensive care. All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with “COVID-19 croup,” SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.

show abstract

Section: Discussionmentioning

confidence: 99%

Pediatric croup with COVID-19

Venn

Schmidt

Mullan

2021

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Fernandes et al found out that using steroids in children who have acute respiratory distress is safe [9]. Dexamethasone is superior to budesonide and prednisolone in the management of croup.…”

Section: Introductionmentioning

confidence: 99%

The Outcome of Immediate Administration of Dexamethasone in Children With Croup (Laryngotracheobronchitis) in King Abdullah Specialized Children’s Hospital

Alqahtani¹,

Masud²,

Algazlan³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundCroup is an inflammatory disease that affects the upper respiratory tract involving the upper airways of the lungs (bronchial tubes), vocal cords (larynx), and windpipe (trachea). In Canada, it is considered one of the major causes of respiratory diseases in the first 10 years of life. A wide range of viruses like common cold and flu (influenza) infections can cause croup (laryngotracheobronchitis). Dexamethasone has been commonly used to treat croup even though it lacks evidence on patients' recovery. The study aimed to compare the effect of the immediate or late dexamethasone administration on patient recovery and identify predictors for relapse among children with croup. MethodsA retrospective cross-sectional study was conducted using the electronic medical record (Best Care) of all croup patients between 2014 and 2018 in King Abdullah Specialized Children's Hospital (KASCH), in Riyadh, Saudi Arabia. Out of the 329, only 186 patients matched our inclusion criteria. Statistical analysis was conducted with the SPSS V.22 software package (IBM Corp., Armonk, NY). The main outcome variable was early recovery or relapse. The chi-square test and logistic regression were used to assess the relationship between the independent variables with recovery or relapse among croup patients. A p-value of <0.05 was used to determine the significance of the test. ResultsFifty-three recovered out of the 186 patients. Moreover, 50 of the recovered patients were treated in the ER. In addition, out of the 53 patients who recovered, 40 patients were treated as inpatients (IPs). Those who were given dexamethasone immediately for both recovery and relapsed groups were 29% and 71%, respectively while those who were given dexamethasone late were 34% for the recovery group. On the other hand, 119 patients relapsed. Out of those patients who relapsed, 111 were treated in the ER. Moreover, out of relapsed patients, 79 patients were treated as IPs. Furthermore, out of 186 patients, 86 had chronic illnesses. Twenty-four percent (24%) of those with chronic illnesses recovered, and 76% relapsed (P-value=0.04). Also, there was a significantly higher trend of administration of dexamethasone immediately in the ER in 69% of children with a p-value <0.001. ConclusionIn conclusion, the difference between the early and late administration of dexamethasone in both recovery and relapse is not significant. Also, the presence of chronic illnesses affects relapses more significantly.

show abstract

“…Several publications regarding management of croup patients have described patient management in the emergency department, steroid and antibiotic therapy, causative organisms, and intensive care unit (ICU) management of intubated patients, [1][2][3] but detailed studies on specific airway management of children needing intubation for croup are scarce. 3 Therefore, we aimed to examine the management of patients intubated for croup in our hospital and determine the risk factors for prolonged intubation in these patients.…”

Section: Introductionmentioning

confidence: 99%

Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup

Tsuboi

et al. 2021

J Pediatr Intensive Care

View full text Add to dashboard Cite

Croup is a common respiratory illness in children with a substantial variation in the severity of symptoms. Most of the patients present with mild symptoms, but patients with severe croup require intensive care unit (ICU) management. The aim of this study was to investigate the airway management of patients with severe croup who required intubation and determine the risk factors for prolonged intubation. We performed an 18-year retrospective observational cohort study at the pediatric ICU of a tertiary children's hospital in Japan. A total of 16 patients with croup who were intubated for upper airway obstruction were included in the study. Most patients (13of 16, 81%) were intubated with an endotracheal tube (ETT) smaller than their age-appropriate size. The median difference in the internal diameter (ID) between the selected ETT and the age-appropriate size was 1.0 mm (interquartile range: 0.5–1.0). Multivariate analysis performed on factors affecting the cumulative incidence of extubation revealed that the difference in ID between the selected ETT and age-appropriate size (mm) significantly reduced the duration of intubation (hazard ratio: 0.092, p = 0.03). A downsized ETT without a cuff may be recommended for intubation of patients with croup.

show abstract

Hospital Course of Croup After Emergency Department Management

Cited by 15 publications

References 11 publications

Pediatric croup with COVID-19

Pediatric croup with COVID-19

The Outcome of Immediate Administration of Dexamethasone in Children With Croup (Laryngotracheobronchitis) in King Abdullah Specialized Children’s Hospital

Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup

Contact Info

Product

Resources

About