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Croup - Evidence
Evidence on the effectiveness of corticosteroids in a child with croup

CKS found good evidence that corticosteroids are beneficial in children with mild, moderate, and severe croup:

  • A Cochrane review investigated the use and effectiveness of glucocorticoids in the treatment of children with croup [Russell et al, 2004]:
    • Studies included were randomized controlled trials that studied children with croup and objectively measured the effectiveness of glucocorticoid treatment. Thirty-one studies met the inclusion criteria (n = 3736).
    • Glucocorticoid treatment was associated with an improvement in the Westley croup score at 6 hours (weighted mean difference [WMD] –1.2, 95% CI –1.6 to –0.8) and at 12 hours (WMD –1.9, 95% CI –2.4 to –1.3); at 24 hours this improvement was no longer significant (WMD –1.3, 95% CI –2.7 to +0.2).
    • There were fewer return visits and/or readmissions in children treated with glucocorticoids (RR 0.50, 95% CI 0.36 to 0.70).
    • The length of time spent in Accident and Emergency or hospitalized (WMD 12 hours, 95% CI 5 to 19) was significantly less for children treated with glucocorticoids.
    • There was less use of epinephrine in children treated with a glucocorticoid (risk difference [the risk in one group minus the risk in the other] 10%, 95% CI 1 to 20).
    • The authors concluded that:
      • Dexamethasone and budesonide are effective in relieving the symptoms of croup as early as 6 hours after treatment.
      • Dexamethasone is also effective in mild croup populations.
  • A randomized double blind placebo-controlled trial of children with mild croup (n = 720) [Bjornson et al, 2004] compared children given one dose of oral dexamethasone (0.6 mg per kg body weight) with placebo.
    • In the dexamethasone group:
      • Return to medical care was significantly lower (7.3% versus 15.3%, p < 0.001).
      • There was quicker resolution of croup symptoms (p = 0.003).
      • There was less lost sleep (p < 0.001).
      • There was less parental stress (p < 0.001).
    • Among the 720 children, there were no cases of gastrointestinal bleeding, complicated varicella, or bacterial tracheitis. There were seven cases of pneumonia (of which three were in the dexamethasone group).
    • The authors concluded that in 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, the data support the use of dexamethasone in most, if not all, children with croup.

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