Management of Croup in the Emergency Department: The Role of Multidose Nebulized Epinephrine

Objectives Croup occasionally requires medical intervention for respiratory distress. Mainstays of treatment are corticosteroids and nebulized epinephrine. Diagnosis and assessment of severity remain clinical. Safety of discharge from an emergency department (ED) after treatment with corticosteroids and 1 nebulized epinephrine has been established. No evidence exists regarding risk associated with discharge after multidose nebulized epinephrine. Many patients requiring multidose nebulized epinephrine are reflexively admitted. The purpose of this study was to provide a descriptive analysis of the current management of croup, specifically patients requiring multidose nebulized epinephrine. Methods The Pediatric Health Information System was used to extract information on patients diagnosed with croup age 0 to 11 years, evaluated in pediatric EDs from 2004 to 2014, who received corticosteroids and at least 1 nebulized epinephrine. We retrospectively assessed patients requiring multidose nebulized epinephrine, evaluating risk of return for additional care associated with discharges and reviewing admissions for markers of disease severity. Results A total of 95,403 patients were identified. Those requiring corticosteroids and multidose nebulized epinephrine (N = 8084) were less likely to return for further care if discharged from the ED (5.4% return single dose, 0.8% return multidose: P
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Original Articles Source Type: research