Prehospital dexamethasone administration in children with croup: a medical record review

Abstract

Objectives:

Croup is one of the most common childhood respiratory illnesses. Early dexamethasone administration in croup can improve patient outcomes. The objective of this study was to assess the clinical impact of prehospital administration of dexamethasone to children with croup.

Methods:

A medical record review that included children between 6 months and 6 years, who were brought via emergency medical services (EMS) to the emergency department (ED) with a final diagnosis of croup, between January 2010 and December 2012, was conducted. Data were collected regarding prehospital management and ED management, length of stay (LOS), final disposition, and patient demographics.

Results:

A total of 188 patients with an ED diagnosis of croup were enrolled, 35.1% (66/188) of whom received a prehospital diagnosis of croup. The mean age of the participants was 32.96±17.18 months and 10.6% (20/188) were given dexamethasone in the prehospital setting by EMS, while 30.3% (57/188) were given epinephrine nebulizations. Out of the 66 patients with a prehospital diagnosis of croup, 10.6% (7/66) were given dexamethasone by EMS. In ED, dexamethasone was administered to 88.3% (166/188) while 29.8% of participants (56/188) received epinephrine nebulizations. There was no significant difference in ED LOS between those who received prehospital dexamethasone (2.6±1.6 hours, n=18) and those who did not (3.3±2.7 hours, n=159) (P=0.514). The number of in-hospital epinephrine doses per patient was significantly influenced by the administration of prehospital dexamethasone (P=0.010).

Conclusions:

Prehospital administration of dexamethasone results in less ED epinephrine use and may reflect dexamethasoneߣs positive influence on the severity and short-term persistence of croup symptoms.

Keywords::

• croup
• emergency medical services
• paramedic
• pediatrics
• steroids

Acknowledgments

We would like to acknowledge Ms Nadia Dow for research coordination assistance, Ms Melissa Gutland for administrative support for this study, the Clinical Research Informatics Core (Women and Childrenߣs Health Research Institute) for database support, and Dr Maryna Yaskina, PhD (Women and Childrenߣs Health Research Institute) for statistical support. Dr Aaron Moodley secured a Women and Childrenߣs Health Research Institute Trainee Research Grant to support this work (2013ߝ2015).

The abstract of this paper was presented at the Canadian Association of Emergency Physicians Annual Meeting (Quebec City, Quebec, Canada) in June 2016 as a poster presentation with interim findings. The posterߣs abstract was published in “Poster Abstracts” in the Canadian Journal of Emergency Medicine.²⁷

Disclosure

The authors report no conflicts of interest in this work.