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Croup - Management
Basis for recommendation
- The recommendations regarding assessment of severity and admission are based on expert opinion in guidelines [Alberta Medical Association, 2008], review articles [Cherry, 2005; Brown, 2006; Fitzgerald, 2006; Bjornson and Johnson, 2008], clinical practice guidelines [Sydney West Area Health Service, 2004], and a text book [Helms and Henderson, 2003]. The most important issue is the maintenance of the airway — if there is any risk of the child developing acute obstruction then they must be admitted to hospital urgently [Brown, 2006].
- There is little evidence to guide clinicians about which children should be admitted to hospital. A study of children (n = 527) admitted to hospital with stridor and/or sternal retractions at rest showed that only 1% of those who had resting stridor but no sternal retraction (n = 305) had worsening respiratory distress after admission [Wagener et al, 1986].
- A child with croup may be pyrexial but should not drool or be toxic (pale, very febrile, and poorly perfused) [Fitzgerald, 2006], and agitation is usually absent in croup [Brown and Klassen, 2000].
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