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World Journal of Pediatrics

, Volume 15, Issue 6, pp 586–594 | Cite as

Inpatient use of racemic epinephrine for children admitted with croup

  • Elaine Chiang
  • Omar Afandi
  • Sang Hoon Lee
  • Srinivasan Suresh
  • Raymond D. Pitetti
  • Sriram RamgopalEmail author
Original Article
  • 80 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Laryngotracheobronchitis Racemic epinephrine Spasmodic croup Steroids Viral croup 

Notes

Author contributions

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.

Funding

None.

Compliance with ethical standards

Ethical approval

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.

References

  1. 1.
    Segal AO, Crighton EJ, Moineddin R, Mamdani M, Upshur RE. Croup hospitalizations in Ontario: a 14-year time-series analysis. Pediatrics. 2005;116:51–5.CrossRefGoogle Scholar
  2. 2.
    Johnson DW. Croup. BMJ Clin Evid. 2014;2014:0321.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, et al. Glucocorticoids for croup in children. Cochrane Database Syst Rev. 2018;8:CD001955.PubMedGoogle Scholar
  4. 4.
    Bjornson C, Russell KF, Vandermeer B, Durec T, Klassen TP, Johnson DW. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. 2011.  https://doi.org/10.1002/14651858.CD006619.pub3.CrossRefPubMedGoogle Scholar
  5. 5.
    Bagwell T, Hollingsworth A, Thompson T, Abramo T, Huckabee M, Chang D, et al. Management of croup in the emergency department: the role of multidose nebulized epinephrine. Pediatr Emerg Care. 2017.  https://doi.org/10.1097/PEC.0000000000001276.CrossRefPubMedGoogle Scholar
  6. 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. 7.
    Seattle Children’s Hospital. Croup Clinical Pathway. 2019. https://www.seattlechildrens.org/pdf/croup-pathway.pdf. Accessed 8 Apr 2019.
  8. 8.
    Narayanan S, Funkhouser E. Inpatient hospitalizations for croup. Hosp Pediatr. 2014;4:88–92.CrossRefGoogle Scholar
  9. 9.
    Delany DR, Johnston DR. Role of direct laryngoscopy and bronchoscopy in recurrent croup. Otolaryngol Head Neck Surg. 2015;152:159–64.CrossRefGoogle Scholar
  10. 10.
    Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH. Croup presentations to emergency departments in Alberta, Canada: a large population-based study. Pediatr Pulmonol. 2010;45:83–91.CrossRefGoogle Scholar
  11. 11.
    Cooper T, Kuruvilla G, Persad R, El-Hakim H. Atypical croup: association with airway lesions, atopy, and esophagitis. Otolaryngol Head Neck Surg. 2012;147:209–14.CrossRefGoogle Scholar
  12. 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
  13. 13.
    Bjornson CL, Klassen TP, Williamson J, Brant R, Mitton C, Plint A, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004;351:1306–13.CrossRefGoogle Scholar
  14. 14.
    Klassen TP. Effectiveness of glucocorticoids in treating croup authors acknowledge cochrane collaboration. BMJ. 1999;319:1577.CrossRefGoogle Scholar
  15. 15.
    Chan PW. Risk factors associated with severe viral croup in hospitalised Malaysian children. Singap Med J. 2002;43:124–7.Google Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2019

Authors and Affiliations

  1. 1.Division of Pediatric Emergency Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Department of PediatricsUniversity of Cincinnati, College of MedicineCincinnatiUSA
  4. 4.Division of Emergency MedicineCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  5. 5.Division of Health Informatics, Department of PediatricsUniversity of Pittsburgh School of Medicine, Children’s Hospital of PittsburghPittsburghUSA
  6. 6.UPMC Children’s Hospital of PittsburghPittsburghUSA

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