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Nebulised epinephrine or corticosteroids in croup
  1. Angaj Ghosh,
  2. Rosemary Morton
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M139WL, UK

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    Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rosemary Morton, Consultant

    Clinical scenario

    A 4 year old girl attends the emergency department with moderately severe croup. You have heard that croup responds to corticosteroid therapy, but wonder whether it is more effective than nebulised epinephrine

    Three part question

    In a [child with croup] is [nebulised epinephrine or nebulised budesonide] more effective at [reducing croup score and length of stay].

    Search strategy

    Medline 1966–11/00 using the OVID interface. [(exp croup OR croup.mp OR exp tracheitis OR laryngotracheitis.mp OR laryngotracheobronchitis.mp OR Stridor.mp) AND (exp epinephrine OR adrenaline.mp OR exp budesonide OR budesonide.mp)] LIMIT to human AND english.

    Search outcome

    Altogether 119 papers found of which 118 were irrelevant or of insufficient quality. The remaining paper is shown in table 4.

    Table 4

    Comments

    This study shows that there are no significant clinical differences between the two treatments. In such a case the relative cost of the treatment is an important factor in deciding which should be prescribed.

    Clinical bottom line

    Nebulised epinephrine and nebulised budesonide are as effective as each other in moderately severe croup.

    Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rosemary Morton, Consultant

    References

    View Abstract

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