Clinical Question: Does a single or...

Clinical Question: Does a single oral dose of dexamethasone improve consequences in patients with mild croup?

Setting: difficulty department

Study Design: Randomized controll trial (double-blinded)

Allocation: Concealed

Synopsis: The authors identified children presenting with les than 72 hours of a seal-like, barking cough and a gentle score (2 or less) onward a validated 17-point croup measure. The score assigns points for inspiratory stridor, retractions, impaired air note cyanosis, and impaired consciousness. Children with signs of epiglottitis, bacterial tracheitis, foreign corpse chronic pulmonary disease, recent varicella, and late steroid treatment were excluded.

The children were assigned randomly (allocation concealed) to receive 06 mg by means of kg of dexamethasone or placebo, with a maximum total dose of 20 mg The placebo had an appearance and flavor similar to the active physic Parents were telephoned on days 1 2 3 7 and 21 The primary consequences (based on the telephone interview) were turn back to a health care professional within seven days of enrollment and continued symptoms upon days 1, 2, and 3 Analysis was through intention to treat. A nerve of the study was the detailed charge analysis, considering costs to the rule that pays for medical care and to the family members who have to care for the child and perhaps miss work.

Of the 2901 patients initially assessed for eligibility, 720 met inclusion criteria and were randomized. Follow-up was crack (97 percent at three days). Children who received dexamethasone were les likely to go [i]or[/i] come back for care within seven days (73 versus 153 percent for placebo; number privationed to treat = 13). This benefit was consistent across arranges although it appeared to be greatest in younger children and those with spasmodic crupper symptoms. Children receiving dexamethasone had lower crupper scores on day 1, although this advantage disappeared by means of day 3, at which time principally patients had fully recovered whether or not they were treated with steroids. Other benefits included improved repose reduction in parental anxiety, and reduc take away from No significant adverse events were attributed to the dexamethasone.

Bottom Line: A single oral dose of dexamethasone (06 mg for kg) improves short-term symptoms and restores the likelihood that a child with mild rump will have to return for additional care. The dexamethasone was well tolerated, and considering the well-documented benefits of steroids in children with more strict disease, steroids in some form should be considered for greatest in quantity children with croup. (Level of Evidence: 1b)

cogitation Reference: Bjornson CL, et al. A randomized trial of a single dose of oral dexamethasone for mild crupper N Engl J Med September 23 2004;351:1306-13

Used with permission from Ebell M Single oral dose dexa-methasone effective for equal mild croup. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

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