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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
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.
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.
Source Information
From the Department of Pediatrics (C.L.B., J.W., D.W.J.), the Department of Community Health Sciences (R.B.), and the Department of Pharmacology and Therapeutics (D.W.J.), University of Calgary, Calgary, Alta.; the Department of Pediatrics, University of Alberta, Edmonton (T.P.K., L.E.); the Center for Healthcare Innovation and Improvement, University of British Columbia, Vancouver (C.M.); the Department of Pediatrics, University of Ottawa, Ottawa, Ont. (A.P.); and the Department of Pediatrics, University of Manitoba, Winnipeg (B.B.) — all in Canada.
Address reprint requests to Dr. Johnson at the Child Health Research Group, Alberta Children's Hospital, 1820 Richmond Rd. SW, Calgary, AB T2T 5C7, Canada.
Related Letters:
Oral Dexamethasone for Mild Croup
Vernacchio L., Mitchell A. A., Marchetti F., Longo G., Ventura A., Singh H., Chugh J. C., Bjornson C., Johnson D. W., Klassen T.
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N Engl J Med 2004;
351:2768-2769, Dec 23, 2004.
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