Original Contributions| Volume 57, ISSUE 3, P314-321, September 2019

Download started.


Rate of Airway Intervention for Croup at a Tertiary Children’s Hospital 2015–2016



      Croup admission decision making is challenging because the rate of further interventions after stabilization is unclear.


      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Denny F.W.
        • Murphy T.F.
        • Clyde W.A.
        • et al.
        Croup: an 11-year study in a pediatric practice.
        Pediatrics. 1983; 71: 871-876
        • Segal A.O.
        • Crighton E.J.
        • Moineddin R.
        • et al.
        Croup hospitalizations in Ontario: a 14-year time-series analysis.
        Pediatrics. 2005; 116: 51-55
        • Cherry J.D.
        Clinical practice. Croup.
        N Engl J Med. 2008; 358: 384-391
        • Klassen T.P.
        Croup. A current perspective.
        Pediatr Clin North Am. 1999; 46: 1167-1178
        • Marx A.
        • Török T.J.
        • Holman R.C.
        • et al.
        Pediatric hospitalizations for croup (laryngotracheobronchitis): biennial increases associated with human parainfluenza virus 1 epidemics.
        J Infect Dis. 1997; 176: 1423-1427
        • Tyler A.
        • McLeod L.
        • Beaty B.
        • et al.
        Variation in inpatient croup management and outcomes.
        Pediatrics. 2017; 139: e20163582
        • Bjornson C.
        • Russell K.F.
        • Vandermeer B.
        • et al.
        Nebulized epinephrine for croup in children.
        Cochrane Database Syst Rev. 2011; 2: CD006619
        • Fifoot A.A.
        • Ting J.Y.
        Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial.
        Emerg Med Australas. 2007; 19: 51-58
        • Russell K.F.
        • Liang Y.
        • O’Gorman K.
        • et al.
        Glucocorticoids for croup.
        Cochrane Database Syst Rev. 2011; 1: CD001955
        • Smith D.K.
        • McDermott A.J.
        • Sullivan J.F.
        Croup: diagnosis and management.
        Am Fam Physician. 2018; 97: 575-580
        • Sharma G.
        • Conrad C.
        Croup, epiglottitis, bacterial tracheitis.
        in: Light M.J. Blaisdell C. Homnick D. Pediatric pulmonology. American Academy of Pediatrics, Washington, DC2011: 347-363
      1. Zaoutis L.B. Chiang V.W. Comprehensive pediatric hospital medicine. Mosby, Philadelphia, PA2007
        • Petrocheilou A.
        • Tanou K.
        • Kalampouka E.
        • et al.
        Viral croup: diagnosis and a treatment algorithm.
        Pediatr Pulmonol. 2014; 49: 421-429
        • Narayanan S.
        • Funkhouser E.
        Inpatient hospitalizations for croup.
        Hosp Pediatr. 2014; 4: 88-92
        • Rudinsky S.L.
        • Sharieff G.Q.
        • Law W.
        • et al.
        Inpatient treatment after multi-dose racemic epinephrine for croup in the emergency department.
        J Emerg Med. 2015; 49: 408-414
        • Feudtner C.
        • Feinstein J.A.
        • Zhong W.
        • Hall M.
        • Dai D.
        Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.
        BMC Pediatr. 2014; 14: 199
        • Hughes H.
        • Kahl L.
        The Harriet Lane Handbook.
        21st ed. Elsevier, Philadelphia, PA2018
        • Bagwell T.
        • Hollingsworth A.
        • Thompson T.
        • et al.
        Management of croup in the emergency department.
        Pediatr Emerg Care. 2017; ([Epub ahead of print])
        • Li S.F.
        The Westley croup score.
        Acad Emerg Med. 2003; 10: 289
        • Yang W.C.
        • Lee J.
        • Chen C.Y.
        • et al.
        Westley score and clinical factors in predicting the outcome of croup in the pediatric emergency department.
        Pediatr Pulmonol. 2017; 52: 1329-1334