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At least 19 recordsLinked to original sources
PubMed1999

Croup and recurrent croup: their association with asthma and allergy. An epidemiological study on 5-8-year-old children.

UNLABELLED: The cumulative incidence (i.e. lifetime prevalence) of croup and recurrent croup (RC) was investigated by questionnaire in a large group (n = 5756) of 5-8-year-old children (mean age: 6.8 +/- 0.6 years) and the risk for asthma and/or wheezing in children with croup and RC assessed. In a random sample of the children, skin prick testing with common inhalant allergens (n = 614) and spirometry (n = 305) were performed and the results were compared between children with or without croup or RC. Of the children, 15.5% had suffered from croup, while 5.0% had had RC. The cumulative incidence was higher in boys than in girls (P < 0.05). In the children with croup or RC an increased risk for wheezing, asthma, usage of anti-asthma medication, rhinitis and hay fever was found (P < 0.01). There was no difference in the prevalence of positive skin prick tests between children with and without croup or RC. Mean percentage predicted forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow was not different between children with and without croup or RC. However, children who had suffered from croup (with or without wheezing) had a lower mean percentage predicted forced expiratory flow at both 50% and 75% of forced vital capacity than those without croup (P = 0.002). A family history of hay fever, chronic bronchitis and eczema was associated with the presence of croup or RC (P < 0.01), while this was hardly the case for a family history of asthma. CONCLUSION: Croup and recurrent croup are associated with bronchial asthma. The association seems essentially based on the presence of hyperreactive airways and less on the presence of atopy, although the latter can be considered an aggravating factor.

Asthma↗
PubMed2002

Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department.

OBJECTIVE: The aim of this study was to evaluate the safety and effectiveness of a clinical pathway for croup in an emergency department (ED). METHODOLOGY: This before-and-after intervention study on all consecutive children aged 6 months to 10 years who presented to our ED with moderate/severe croup was conducted over a 6-month period. Children with a clinical croup score (CSS) of 2 or more and resting stridor were considered eligible for entry into the study. Children were treated with either oral dexamethasone, or a combination of oral dexamethasone suspension and nebulized adrenaline. Children were clinically assessed, observed in the emergency short-stay ward and discharged or admitted according to the clinical pathway. The following outcomes were measured: admission rates, hospital re-presentation, length of stay, and adverse clinical events. Children in the post-intervention group were followed up by telephone within 48 h of discharge. RESULTS: There were 157 patients recruited in the pre-intervention group and 110 in the post-intervention group. Significant reductions were reported in the length of stay (18.9 h compared with 5.2 h), hospital admission (52.9% compared with 18.0%) and intensive care admission (10.2% compared with 0.0%) after the introduction of the croup clinical pathway. No children in the study experienced an adverse clinical event. Follow-up interviews of parents indicated that the new treatment strategy was well received. CONCLUSION: The use of the croup clinical pathway in the ED is safe and effective in guiding consistent management, resulting in reduced admission rates, earlier discharge home, and no reported adverse events.

Anti-Inflammatory Agents↗
PubMed1994

Validation of a croup score and its use in triaging children with croup.

The Syracuse croup scoring system was validated in 165 children with croup who were admitted to an intensive therapy unit for assessment over a one year period. The unit served as a croup triage point for Cardiff and its environs. A score of > 5 was taken as an indication that a patient was at risk of upper airway obstruction and was used to support a triage decision by the junior hospital doctor to admit a patient to the intensive therapy unit. All patients with an initial score < or = 5 were considered safe for transfer to a general paediatric ward and none of these required subsequent admission to intensive care. This score was then tested on a further 134 children with croup, in order to identify those patients who required specialised monitoring, observation or treatment in intensive care. A score of > 5 gave a specificity of 100% and a sensitivity of 80%. Croup scoring continued after admission on the general paediatric wards. Two patients who were originally admitted to the intensive therapy unit with a score > 5 improved within 6 h and were transferred to the general ward with a score < or = 5. These children subsequently required readmission to the intensive therapy unit. Our tracheal intubation rate of 2% was low and may relate to the routine use of regular adrenaline nebulisation. We recommend this scoring system to other paediatric departments for initial triaging decisions and for documenting progress on the wards.

Child↗
PubMed1983

Croup: an 11-year study in a pediatric practice.

The etiology and epidemiology of croup were studied in a pediatric group practice over an 11-year period, 1964 to 1975. Croup was diagnosed in 951 instances in 6,165 cases of lower respiratory tract infection (LRI) studied. As census figures of the practice clientele were available, attack rates were calculated. The incidence of total LRI was highest in the first year of life. In contrast, the attack rate for croup was highest in the second year of life; the rate declined gradually after that age. Croup was not diagnosed in the first month of life. Boys were 1.43 times more likely to develop croup than were girls. Three hundred sixty agents were isolated from the 951 croup cases. The parainfluenza viruses accounted for 74.2% of all isolates; 65% of the parainfluenza isolates were classified as parainfluenza virus type 1. Respiratory syncytial virus, influenza viruses A and B, and Mycoplasma pneumoniae were the only other agents isolated in appreciable numbers. The propensity of various agents to produce croup symptoms in children with LRI due to specific microorganisms was 58% for parainfluenzae type 1,60% for parainfluenzae type 2, and 29% for parainfluenzae type 3; similar figures for the other agents varied from 5% to 16%. The role of the various agents in the etiology of croup varied with patient age and depended on the propensity of the agent to produce the croup syndrome and the frequency of isolation of the agent at that age. The parainfluenza viruses were the most important croup agents at all ages; respiratory syncytial virus caused croup in children less than 5 years of age whereas the influenza viruses and M pneumoniae were significant causes of croup only in children more than 5 to 6 years old. Croup occurred predominately in late fall and early winter, times when the parainfluenza viruses, especially type 1, occurred most frequently. The epidemiology of croup differs from that of bronchiolitis, pneumonia, and tracheobronchitis; knowledge of this should be helpful to the clinician caring for children with LRI.

Age Factors↗
PubMed1988

Recurrent and non-recurrent croup: an epidemiological study.

A community-based study investigating the natural history of recurrent and non-recurrent croup is described. Daily temperature data were collected during 1977-83, in order to analyse seasonal variation and the effect of atmospheric temperature on the number of croup episodes per calendar month. A case-control study of 137 cases--consisting of 75 children with recurrent croup and 45 children with non-recurrent croup--and 236 controls matched by age and sex was also conducted. It aimed to study associations between croup and other selected diseases in the patients and their families. Recurrent croup differed from non-recurrent croup in its natural history in a number of ways. There was a winter and autumn peak in the number of episodes per month. These episodes occurred on days with significantly lower maximum and minimum temperatures. Recurrent croup was significantly associated with a patient history of asthma and wheezy bronchitis and a family history of croup. In contrast, non-recurrent croup showed an autumn peak only, as well as no association with atmospheric temperature or other disease in the patients and their families. This study confirms and extends observations indicating that recurrent croup involves a persistent and inherited airways hyper-reactivity that is triggered by viral and other stimuli, including those related to temperature.

Asthma↗
PubMedDate not supplied

Pulmonary arterial pressure in children with croup syndrome.

PURPOSE: Croup syndrome or laryngotracheitis is one of the frequent causes of transient upper airway obstruction by laryngeal and tracheal blockage in infants and children. Upper airway obstruction may lead to increased pulmonary arterial pressure in children. In this study, the relationship between croup syndrome and pulmonary arterial pressure was investigated. MATERIALS AND METHODS: Forty children with croup syndrome and 14 healthy, age- and sex-matched control subjects were enrolled in this study. Of all patients, 12 with severe symptoms, such as dyspnea, cyanosis, hypoventilation, were accepted as "high croup score" (croup score >or=6). All patients with high croup score were treated with dexamethasone. We assessed pulmonary arterial pressure of patients during therapy using serial echocardiographic measurements. RESULTS: Our results showed that children with croup syndrome have significantly higher pulmonary arterial pressures than healthy subjects at the time of diagnosis. Pressure values of patients with high croup score were found to be significantly higher when compared with those of the low -core group (P < .05). However, there was no difference between 2 groups at the end of therapy. CONCLUSIONS: It is suggested that pulmonary arterial pressure increased to different extents in the acute stage of illness and that the degree of increase was related to the severity of disease and average hospital stay. In addition, increased pulmonary arterial pressure due to croup syndrome is reversible. Furthermore, evaluation of children with croup syndrome by using Doppler echocardiography may be useful in the monitoring of pulmonary arterial pressure and in the follow-up of their therapy.

Blood Pressure↗
PubMed2004

A randomized trial of a single dose of oral dexamethasone for mild croup.

BACKGROUND: The benefits of dexamethasone treatment for moderate-to-severe croup are well established. However, most children with croup have mild symptoms, and it is unknown whether they would derive the same degree of benefit from dexamethasone treatment as children with more severe disease. METHODS: We conducted a double-blind trial at four pediatric emergency departments in which 720 children with mild croup were randomly assigned to receive one oral dose of either dexamethasone (0.6 mg per kilogram of body weight) or placebo. The children had mild croup, as defined by a score of < or =2 on the croup scoring system of Westley et al. The primary outcome was a return to a medical care provider for croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child's illness. RESULTS: Baseline clinical characteristics were similar in the two groups. Return to medical care was significantly lower in the dexamethasone group (7.3 percent vs. 15.3 percent, P<0.001). In the dexamethasone group, there was quicker resolution of croup symptoms (P=0.003), less lost sleep (P<0.001), and less stress on the part of the parent (P<0.001). CONCLUSIONS: For children with mild croup, dexamethasone is an effective treatment that results in consistent and small but important clinical and economic benefits. Although the long-term effects of this treatment are not known, our data support the use of dexamethasone in most, if not all, children with croup.

Administration, Oral↗
PubMed2002

A randomized controlled trial of mist in the acute treatment of moderate croup.

OBJECTIVE: To determine whether the use of mist improves clinical symptoms in children presenting to the emergency department (ED) with moderate croup. METHODS: Children 3 months to 6 years of age were eligible for the study if they presented to the ED with moderate croup. Moderate croup was defined as a croup score of 2-7. The patients were randomly assigned to receive either mist (humidified oxygen) via mist stick or no mist. The patients had croup scores measured at baseline and every 30 minutes for up to two hours. At these intervals the following parameters were also measured: heart rate, respiratory rate, oxygen saturation, and patient comfort score. The patients were treated until the croup score was less than 2 or until two hours had elapsed. All patients initially received a dose of oral dexamethasone (0.6 mg/kg). Other treatments, such as racemic epinephrine or inhaled budesonide, were given at the discretion of the treating physician. The research assistants were unaware of the assigned treatments. RESULTS: There were 71 patients enrolled in the study; 35 received mist and 36 received no mist. The two treatment groups had similar characteristics at baseline. The median baseline croup score was 4 in both groups. The outcomes were measured as the change from baseline at 30, 60, 90, and 120 minutes. The change in the croup score from baseline in the mist group was not statistically different from the croup score change in the group that did not receive mist (p = 0.39). There was also no significant difference in improvement of oxygen saturation, heart rate, or respiratory rate at any of the assessment times. There was no adverse effect from the mist therapy. CONCLUSIONS: Mist therapy is not effective in improving clinical symptoms in children presenting to the ED with moderate croup.

Acute Disease↗
PubMed2004

Glucocorticoids for croup.

BACKGROUND: Since the initial version of this systematic review in 1997, a number of randomised trials examining the benefit of glucocorticoids have been published, reflecting a continued interest in the use of glucocorticoids to treat patients with croup. The objective of this review was to provide evidence to guide clinicians in their treatment of patients with croup by determining the effectiveness of glucocorticoids and to identify areas of uncertainty for future research. OBJECTIVES: To determine the effect of glucocorticoids for children with croup. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (issue 1, 2003), MEDLINE (January 1966 to April 2003) and Excerpta Medica/EMBASE (January 1974 to August 2003). We also contacted authors of identified croup trials published in the last ten years to inquire about additional published or unpublished trials. SELECTION CRITERIA: Randomised controlled trials that examine children with croup and objectively measure the effectiveness of glucocorticoid treatment. DATA COLLECTION AND ANALYSIS: Based on review of the title and abstract (when available), two researchers identified studies for potential relevance. The complete text was retrieved and using a priori inclusion criteria, the studies were independently reviewed for relevance by two reviewers. Two observers independently assessed quality. Differences with respect to inclusion status and quality assessment were resolved by consensus. Data were extracted using a structured form by one reviewer and checked for accuracy by a second reviewer. Standard statistical analyses were performed. MAIN RESULTS: Thirty-one studies were deemed relevant for inclusion (N = 3736). Glucocorticoid treatment was associated with an improvement in the Westley score at six hours with a weighted mean difference of -1.2 (95% confidence interval -1.6 to -0.8) and at 12 hours -1.9 (-2.4 to -1.3); at 24 hours this improvement was no longer significant (-1.3, -2.7 to 0.2). Fewer return visits and/or (re)admissions occurred in patients treated with glucocorticoids (relative risk 0.50; 0.36 to 0.70). Length of time spent in accident and emergency or hospital (weighted mean difference 12 hours, five to 19 hours) was significantly decreased for patients treated with glucocorticoids. Use of epinephrine decreased for children treated with a glucocorticoid (risk difference 10%; 1 to 20). No other decreases in additional treatments were found in the primary analysis. Publication bias does not impact results importantly. No between-trial significant differences were found between populations with mild and moderate croup. Oral dexamethasone may be superior to intramuscular dexamethasone. REVIEWER'S CONCLUSIONS: Dexamethasone and budesonide are effective in relieving the symptoms of croup as early as six hours after treatment. Fewer return visits and/or (re)admissions are required and the length of time spent in hospital is decreased in inpatients. Dexamethasone is also effective in mild croup populations. Research is required to examine the most beneficial method for disseminating croup practice guidelines and to increase the uptake of evidence to improve outcomes.

Croup↗
PubMed2007

A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup.

BACKGROUND: Although previous studies have shown that dexamethasone is useful in croup, the optimal dosage has not been clarified yet. The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup. METHOD: Forty-one children aged 6 months to 5 years admitted from March 2001 to October 2003 at the pediatric ward of Hatyai Hospital with moderate to severe croup were recruited for the study. After random allocation, each child received a single intravenous injection of either dexamethasone 0.6 mg/kg (maximum dose 12 mg) or 0.15 mg/kg (maximum dose 3 mg). All children were given a single dose of epinephrine nebulization at the beginning of the study. The croup scores were measured at 0, 1, 2, 3, 4, 6, 8, 10 and 12 h after the dexamethasone injection. RESULTS: One hour following the injection, the mean croup scores were significantly reduced from baseline values in both groups (p<0.01). There was no difference in the mean croup scores between the two groups at any time. Median times to croup scores equal or less than two in both high- and low-dose groups were 8 and 7.9 h, respectively. No patient required intubation or was removed from the study because of a rising croup score after enrollment. There was no significant adverse reaction from dexamethasone treatment in either group. CONCLUSION: Dexamethasone 0.15 and 0.6 mg/kg are equally effective in the treatment of moderate to severe croup.

Anti-Inflammatory Agents↗
PubMed1996

Use of racemic epinephrine, dexamethasone, and mist in the outpatient management of croup.

This study aims to determine whether a subpopulation of children with croup, given mist and dexamethasone, can be treated with nebulized racemic epinephrine and safely discharged after observation in the emergency department. A prospective study was designed, enrolling children aged three months to six years with a clinical diagnosis of croup. Croup scores were assigned on arrival, after 30 minutes of saline mist, and 30, 120, and 240 minutes after nebulized racemic epinephrine. All children received mist; those with a croup score > 3 after mist were given nebulized racemic epinephrine. All patients received intramuscular dexamethasone. Patients were discharged if they were significantly improved after four hours of observation. Phone follow-up occurred 24 to 48 hours after discharge. Sixty children received racemic epinephrine for croup. The median croup score on arrival was 5, and there was no difference in arrival croup score by disposition. The two-hour croup score was significantly higher for admitted patients (P < 0.05 by the Mann-Whitney U test). Forty children (66%) were discharged after nebulized racemic epinephrine and four hours of observation. No patients returned to the emergency department within 24 hours for further treatment. Two patients could not be contacted. The 95% confidence interval for 0/38 patients with a negative outcome is (0-9.3%). We conclude that children with croup treated with dexamethasone and mist, receiving one nebulized racemic epinephrine treatment, can be discharged after a four-hour period of observation if they appear clinically well to an experienced physician, and if close follow-up can be established.

Ambulatory Care↗