title: Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department.
abstract: OBJECTIVE
  The aim of this study was to evaluate the safety and effectiveness of a clinical pathway for croup in an emergency department (ED).
  
  
  METHODS
  This before-and-after intervention study on all consecutive children aged 6 months to 10 years who presented to our ED with moderate/severe croup was conducted over a 6-month period. Children with a clinical croup score (CSS) of 2 or more and resting stridor were considered eligible for entry into the study. Children were treated with either oral dexamethasone, or a combination of oral dexamethasone suspension and nebulized adrenaline. Children were clinically assessed, observed in the emergency short-stay ward and discharged or admitted according to the clinical pathway. The following outcomes were measured: admission rates, hospital re-presentation, length of stay, and adverse clinical events. Children in the post-intervention group were followed up by telephone within 48 h of discharge.
  
  
  RESULTS
  There were 157 patients recruited in the pre-intervention group and 110 in the post-intervention group. Significant reductions were reported in the length of stay (18.9 h compared with 5.2 h), hospital admission (52.9% compared with 18.0%) and intensive care admission (10.2% compared with 0.0%) after the introduction of the croup clinical pathway. No children in the study experienced an adverse clinical event. Follow-up interviews of parents indicated that the new treatment strategy was well received.
  
  
  CONCLUSIONS
  The use of the croup clinical pathway in the ED is safe and effective in guiding consistent management, resulting in reduced admission rates, earlier discharge home, and no reported adverse events.
authors.affiliation: Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Chin
authors.forename: G J
authors.initials: GJ
authors.lastname: Browne
authors.forename: L T
authors.initials: LT
authors.lastname: Lam
authors.forename: M E
authors.initials: ME
authors.lastname: McCaskill
authors.forename: B
authors.initials: B
authors.lastname: Fasher
authors.forename: J
authors.initials: J
authors.lastname: Hort
mesh_terms: D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D003440:Croup / Q000628:therapy*; D003907:Dexamethasone / Q000008:administration & dosage; D004636:Emergency Service, Hospital / Q000592:standards*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D010343:Patient Admission
chemical_list: D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D003907:Dexamethasone; D004837:Epinephrine