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Prehospital dexamethasone administration in children with croup: a medical record review

Authors Ali S, Moodley A, Bhattacharjee A, Chang E, Kabaroff A, Lobay K, Allain D

Received 20 March 2018

Accepted for publication 3 July 2018

Published 16 October 2018 Volume 2018:10 Pages 141—147

DOI https://doi.org/10.2147/OAEM.S168728

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Hans-Christoph Pape


Samina Ali,1,2 Aaron Moodley,3 Amrita Bhattacharjee,4 Eddie Chang,5 Allison Kabaroff,5 Kevin Lobay,5 Dominic Allain6

1Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; 2Women and Children’s Health Research Institute, Edmonton, AB, Canada; 3Department of Pediatrics, Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada; 4Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; 5Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; 6Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

Objectives:
Croup is one of the most common childhood respiratory illnesses. Early dexamethasone administration in croup can improve patient outcomes. The objective of this study was to assess the clinical impact of prehospital administration of dexamethasone to children with croup.
Methods: A medical record review that included children between 6 months and 6 years, who were brought via emergency medical services (EMS) to the emergency department (ED) with a final diagnosis of croup, between January 2010 and December 2012, was conducted. Data were collected regarding prehospital management and ED management, length of stay (LOS), final disposition, and patient demographics.
Results: A total of 188 patients with an ED diagnosis of croup were enrolled, 35.1% (66/188) of whom received a prehospital diagnosis of croup. The mean age of the participants was 32.96±17.18 months and 10.6% (20/188) were given dexamethasone in the prehospital setting by EMS, while 30.3% (57/188) were given epinephrine nebulizations. Out of the 66 patients with a prehospital diagnosis of croup, 10.6% (7/66) were given dexamethasone by EMS. In ED, dexamethasone was administered to 88.3% (166/188) while 29.8% of participants (56/188) received epinephrine nebulizations. There was no significant difference in ED LOS between those who received prehospital dexamethasone (2.6±1.6 hours, n=18) and those who did not (3.3±2.7 hours, n=159) (P=0.514). The number of in-hospital epinephrine doses per patient was significantly influenced by the administration of prehospital dexamethasone (P=0.010).
Conclusions: Prehospital administration of dexamethasone results in less ED epinephrine use and may reflect dexamethasone’s positive influence on the severity and short-term persistence of croup symptoms.

Keywords:
croup, emergency medical services, paramedic, pediatrics, steroids

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