Report by: Christopher Port, Attending Physician

Search checked by: Michael Brown and Jeff Jones, Attending Physicians

Institution: Grand Rapids MERC

THREE-PART QUESTION

In [a child with croup] is [low dose oral dexamethasone (0.15 mg/kg or 0.3 mg/kg) as good as 0.6 mg/kg] at [reducing croup score and length of stay]?

CLINICAL SCENARIO

A 2-year-old child presents to the emergency department with respiratory distress and stridor. You suspect croup and want to include dexamethasone in the child’s treatment. You wonder what dose of steroids is best to reduce symptoms and hospital length of stay.

SEARCH STRATEGY

Ovid Medline 1950 to November week 3 2008

{[exp Dexamethasone/or dexamethasone.mp or steroid.mp. or exp Steroids/or glucocorticoid.mp. or exp Glucocorticoids/or corticosteroid.mp] AND and [croup.mp. or exp Croup/or laryngotracheobronchitis.mp]}

SEARCH OUTCOME

A total of 222 papers was found, of which one was found to be relevant.

COMMENT(S)

Croup is a common diagnosis made in the emergency department. Steroids have become part of the standard treatment but the ideal dose is not known. This evidence shows that 0.15 mg/kg is just as effective. Geelhoed and Macdonald followed up this study with a placebo controlled study in mild croup giving 0.15 mg/kg to patients and showed it was effective in decreasing return visits to the emergency department.