title: Use of racemic epinephrine, dexamethasone, and mist in the outpatient management of croup.
abstract: This study aims to determine whether a subpopulation of children with croup, given mist and dexamethasone, can be treated with nebulized racemic epinephrine and safely discharged after observation in the emergency department. A prospective study was designed, enrolling children aged three months to six years with a clinical diagnosis of croup. Croup scores were assigned on arrival, after 30 minutes of saline mist, and 30, 120, and 240 minutes after nebulized racemic epinephrine. All children received mist; those with a croup score > 3 after mist were given nebulized racemic epinephrine. All patients received intramuscular dexamethasone. Patients were discharged if they were significantly improved after four hours of observation. Phone follow-up occurred 24 to 48 hours after discharge. Sixty children received racemic epinephrine for croup. The median croup score on arrival was 5, and there was no difference in arrival croup score by disposition. The two-hour croup score was significantly higher for admitted patients (P < 0.05 by the Mann-Whitney U test). Forty children (66%) were discharged after nebulized racemic epinephrine and four hours of observation. No patients returned to the emergency department within 24 hours for further treatment. Two patients could not be contacted. The 95% confidence interval for 0/38 patients with a negative outcome is (0-9.3%). We conclude that children with croup treated with dexamethasone and mist, receiving one nebulized racemic epinephrine treatment, can be discharged after a four-hour period of observation if they appear clinically well to an experienced physician, and if close follow-up can be established.
authors.affiliation: University of Utah School of Medicine, Emergency Department, Primary Children's Medical Center, Salt Lake City 84113, USA.
authors.forename: N C
authors.initials: NC
authors.lastname: Kunkel
authors.forename: M D
authors.initials: MD
authors.lastname: Baker
mesh_terms: D000553:Ambulatory Care; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003440:Croup / Q000145:classification / Q000628:therapy*; D003907:Dexamethasone / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D064705:Racepinephrine; D012138:Respiratory Therapy; D012965:Sodium Chloride / Q000627:therapeutic use
chemical_list: D001993:Bronchodilator Agents; D012965:Sodium Chloride; D003907:Dexamethasone; D064705:Racepinephrine; D004837:Epinephrine