Inpatient use of racemic epinephrine for children admitted with croup
- 80 Downloads
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.
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.
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.
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.
KeywordsLaryngotracheobronchitis Racemic epinephrine Spasmodic croup Steroids Viral croup
EC and SR conceptualized and designed the study, drafted the initial manuscript, collected data, and carried out the analysis. OA, SHL and SS designed the study, collected data, and revised the manuscript for intellectually important content. RDP conceptualized the study and critically revised the manuscript for intellectually important content. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Compliance with ethical standards
This study has been approved by the University of Pittsburgh Institutional Review Board (Protocol #: PRO14030018).
Conflict of interest
The authors have no conflicts of interest relevant to this article to disclose.
- 6.Children’s Hospital of Philadelphia. Croup Clinical Pathway. 2018. https://www.chop.edu/clinical-pathway/croup-emergent-evaluation-clinical-pathway. Accessed 19 Aug 2018.
- 7.Seattle Children’s Hospital. Croup Clinical Pathway. 2019. https://www.seattlechildrens.org/pdf/croup-pathway.pdf. Accessed 8 Apr 2019.
- 12.Chameides L, Ralston M, American Academy of Pediatrics, American Heart Association. Pediatric advanced life support: provider manual. Dallas: American Heart Association; 2011.Google Scholar
- 15.Chan PW. Risk factors associated with severe viral croup in hospitalised Malaysian children. Singap Med J. 2002;43:124–7.Google Scholar