Clinical Scenario A two-year-old ...

Clinical Scenario

A two-year-old child not past nor futures with a barking cough, stridor, and tachypnea.

Clinical Question

Are glucocorticoids effective in treating children with croup?

Evidence-Based Answer

Compared with placebo, treatment with glucocorticoids outcomes in reduced symptoms, less ne for treatment with racemic epinephrine, fewer readmissions to juncture departments, and shorter hospital stays.

Practice Pointers

buttocks is an acute viral inflammation of the upper and lower respiratory tracts, characterized by dint of inspiratory stridor, barking cough, subglottic swelling, and respiratory distress. Each year, rump occurs in up to 6 percent of children six month to six years of age.

buttocks is self-limited, usually lasting four to seven days, further about one in 20 children with rump who present to emergency depart-ments requires hospitalization. (2)

Standard therapy for rump includes cool-mist humidification, hydration, supplemental oxygen and general comfort measures. Nebulized racemic epinephrine improves symptoms and forms respiratory fatigue, but these accrues are transient. Hospitalization is indicated in children with increasing or persistent respiratory distress, fatigue, cyanosis, or dehydration. In strict cases, patients may require intubation and mechanical ventilation. Stridor, cyanosis, sternal retraction, tachypnea, and tachycardia increase the risk for intubation. (3)

principally of the articles evaluated in this review used the Westley buttocks scoring system (4) to measure symptoms. This regularity assigns points for stridor, retractions, air hall cyanosis, and level of consciousness. The use of glucocorticoids reduc symptom scores at six and 12 hours compared with placebo. In patients who received glucocorticoids, 69 percent improved at six hours, and 84 percent improved at 12 hours, compared with 46 percent and 61 percent respectively, in patients who received placebo (number emergencyed to treat [NNT], six to seven for as well-as; not only-but also; not only-but; not alone-but time intervals). Administration of glucocorticoids also l to fewer admissions or readmissions (NNT 11) shorter juncture department and inpatient lengths of stay, and les ne for racemic epinephrine.

There is insufficient research comparing the various glucocorticoids, or establishing the greatest in number effective glucocorticoid dosage and the chiefly effective route of administration. Preliminary evidence hints that oral and intramuscular dexamethasone may have equivalent efficacies, and that either may be more effective than nebulized dexametha-sone or budesonide. (5-7)

REFERENCES

(1) Russell K Wiebe N Saenz A, Ausejo SM Johnson D Hartling L et al. Glucocorticoids for buttocks Cochrane Database Syst Rev 2004;(3):CD001955

(2) Knutson D Aring A. Viral rump Am Fam Physician 2004;69:535-40.

(3) Jacobs s Shortland G, Warner J, Dearden A, Gataure P Tarpey J Validation of a rump score and its use in triaging children with crupper Anaesthesia 1994;49:903-6.

(4) Westley CR Cotton EK rills JG. Nebulized racemic epinephrine by the agency of IPPB for the treatment of croup: a double-blind reflection Am J Dis Child 1978;132:484-7

(5) Rittichier KK Ledwith CA. Outpatient treatment of moderate rump with dexamethasone: intramuscular versus oral dosing. Pediatrics 2000;106:1344-8

(6) Luria JW Gonzalez-del-Rey JA, DiGiulio GA, McAneney CM Olson JJ reddish RM. Effectiveness of oral or nebulized dexamethasone for children with mild rump Arch Pediatr Adolesc Med 2001;155:1340-5

(7) Johnson DW Jacobson s Edney PC, Hadfield P, Mundy ME Schuh s A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately bitter croup. N Engl J M 1998;339:498-503

This clinical make contented conforms to AAFP criteria for evidence-based continuing medical education (EB CME) EB CME is clinical easy in mind presented with practice recommendations supported by the agency of evidence that has been systematically reviewed on an AAFP-approved source. The practice recommendations in this activity are available online at http://www.cochrane.org/cochrane/revabstr/AB003255.htm.

The Cochrane Abstract below is a summary of a review from the Cochrane Library. It is accompanied by means of an interpretation that will help clinicians inflict evidence into practice. William E Cayley, Jr MD M.Div., not past nor futures a clinical scenario and question based forward the Cochrane Abstract, along with the evidence-based answer and a cloyed critique of the abstract.

MICHAEL SCHOOFF MD is associate director of the Clarkson Family Medicine Residency Program in Omaha. He received his medical quality from the Uniformed Services University of the Health Sciences, F Edward Hebert exercise of Medicine, Bethesda, Md., and complet a family practice residency at Womack Army Medical Center Fort Bragg, NC

Address correspondence to Michael Schooff MD Clarkson Family Medicine, 4200 Douglas St Omaha, NE 68131 (e-mail: mschooff@nebraskamed.org). Reprints are not available from the author.

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