Abstract
Background
Croup admission decision making is challenging because the rate of further interventions
after stabilization is unclear.
Objective
We sought to describe rates of inpatient racemic epinephrine (IRE) and additional
inpatient airway interventions (IAI) (oxygen or heliox therapy, intubation, or transfer
to an intensive care unit) among patients presenting to a tertiary children's hospital
with croup.
Methods
This was a retrospective descriptive study including patients (3 months to 8 years
of age) with an emergency department (ED)/inpatient encounter for croup from January
1, 2015 to December 31, 2016 at a tertiary children's hospital. We excluded intensive
care unit direct admissions and patients with bronchiolitis/asthma/pneumonia. We compared
3 groups (a weighted random 5% sample of patients evaluated in ED only, and those
admitted with or without IRE/IAI) using Kruskal-Wallis, Pearson χ2, or the Fischer exact test, where appropriate. We used multivariate analysis to compare
demographics and preadmission racemic epinephrine (RE) with rates of IRE/IAI in admitted
patients.
Results
We included 588 patients (194 discharged from the ED, 394 admitted). In admitted patients,
20.8% (82/394) had IRE/IAI, most commonly IRE (20.0%, 79/394). Three admitted patients
(0.76%) had IAI. Overall, patients with 2 outside hospital/ED doses of RE had a 12.1%
rate of IRE/IAI (23.5% if ≥3 RE doses). Patients with ≥3 preadmission RE doses were
more likely to have IRE/IAI compared with 2 RE (adjusted odds ratio = 2.08 [95% confidence
interval 1.15–3.76]; p = 0.02); there were no other significant associations.
Conclusions
We found a low rate of IRE/IAI after ED management in patients with croup and no significant
associations aside from preadmission RE doses. These findings may be considered in
admission decisions.
Keywords
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Article info
Publication history
Published online: August 12, 2019
Accepted:
June 8,
2019
Received in revised form:
May 20,
2019
Received:
February 11,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
