Inpatient Hospitalizations for Croup

Abstract

Objectives: Croup is a common childhood respiratory illness that can result in hospitalization and significant morbidity. This study reviewed records of patients hospitalized with croup to determine characteristics associated with increased inpatient treatment and length of stay (LOS). Methods: Eligible patients were admitted between January 2006 and December 2010 and had discharge diagnosis of croup. Patients were included if they received either racemic epinephrine or systemic corticosteroids during their emergency department or hospital treatment. Patients were excluded for incomplete data on medication or vital signs timing. Hospitalization and treatment decisions were at the discretion of the treating physician. Results: The study analyzed 365 hospitalizations involving 327 patients, 72% male, 62% white, with median age of 16.7 months. Median LOS was 31.7 hours. Patients required racemic epinephrine treatments after hospitalization in 179 cases (49%; mean, 1.33 treatments; range, 0–13; median, 0), and 176 patients (48%) received a dose of systemic corticosteroids after hospital admission. Patients who required racemic epinephrine treatments after hospitalization were indistinguishable from those who did not, based on demographics, past history, or presenting vital signs. Patients with history of croup, history of intubation, or with oxygen saturation <95% on presentation all had increased LOS compared with those without these findings (P < .05). Conclusions: Fifty-one percent of patients hospitalized with croup did not require inpatient racemic epinephrine treatments. Those with lower oxygen saturations on presentation or past history of croup or intubation were more likely to have prolonged or complicated hospital course.

Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department

“…Although the median length of ED observation in our cohort was 2.8 h, median disposition decision time was only 6 min. Our rate of inpatient RE use, which was lower than the 51% reported in a recent inpatient series, suggests that a longer period of observation in the ED after a second RE dose could have reduced the number of admissions (24).…”

“…The available documentation did not allow retrospective determination of disease severity with the validated five-item respiratory clinical score used in prospective trials (5,24,25,27). However, we retrospectively estimated croup severity using a clinical classification recommended by authorities in the assessment and management of croup (13,14,27,28).…”

Management of respiratory tract infections in children

“…26 In a study of 327 children hospitalized with croup, the median age at presentation was 16.7 months. 27 A prodrome of low-grade pyrexia, coryzal symptoms, and a mild cough may precede the main symptoms of croup in some cases. Inspiratory stridor may develop in some children, and becomes prominent when the child cries or becomes upset.…”

“…In a study of 327 children with 365 hospitalization episodes for croup, 48% were given a dose of systemic corticosteroids post admission to hospital. 27 A need for nebulized adrenaline could not be predicted by demographics, past history, or presenting vital signs. The median length of stay in the study group was 31.7 hours.…”

Defining atypical croup: A case report and review of the literature

“…In cases of failure of medical treatment, progression to exhaustion from increased work of breathing, hypercapnic or hypoxic respiratory failure, or imminent airway obstruction, treatment with endotracheal intubation is warranted. The incidence of intubation is approximately 3% for all patients admitted for croup [8][9][10].…”