A randomized trial of a single dose of oral dexamethasone for mild croup.

Abstract

BACKGROUND:

The benefits of dexamethasone treatment for moderate-to-severe croup are well established. However, most children with croup have mild symptoms, and it is unknown whether they would derive the same degree of benefit from dexamethasone treatment as children with more severe disease.

METHODS:

We conducted a double-blind trial at four pediatric emergency departments in which 720 children with mild croup were randomly assigned to receive one oral dose of either dexamethasone (0.6 mg per kilogram of body weight) or placebo. The children had mild croup, as defined by a score of < or =2 on the croup scoring system of Westley et al. The primary outcome was a return to a medical care provider for croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child's illness.

RESULTS:

Baseline clinical characteristics were similar in the two groups. Return to medical care was significantly lower in the dexamethasone group (7.3 percent vs. 15.3 percent, P<0.001). In the dexamethasone group, there was quicker resolution of croup symptoms (P=0.003), less lost sleep (P<0.001), and less stress on the part of the parent (P<0.001).

CONCLUSIONS:

For 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, our data support the use of dexamethasone in most, if not all, children with croup.

• Authors: Candice L Bjornson, Terry P Klassen, Janielee Williamson, Rollin Brant, Craig Mitton, Amy Plint, Blake Bulloch, Lisa Evered, David W Johnson, Pediatric Emergency Research Canada Network
• Journal: The New England journal of medicine (N Engl J Med) Vol. 351 Issue 13 Pg. 1306-13 (Sep 23 2004) ISSN: 1533-4406 [Electronic] United States
• PMID: 15385657 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2004 Massachusetts Medical Society

Chemical References

• Glucocorticoids
• Dexamethasone

Topics

• Administration, Oral
• Child, Preschool
• Croup (classification, drug therapy, economics)
• Dexamethasone (adverse effects, economics, therapeutic use)
• Double-Blind Method
• Female
• Glucocorticoids (adverse effects, economics, therapeutic use)
• Health Care Costs
• Humans
• Infant
• Logistic Models
• Male
• Parents (psychology)
• Primary Health Care (economics, statistics & numerical data)
• Severity of Illness Index
• Sleep
• Statistics, Nonparametric