A randomized trial of a single dose of oral dexamethasone for mild croup.
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 < or =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.


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.
Bjornson
Candice L
CL
Department of Pediatrics, University of Calgary, Calgary, Alta, Canada.
Klassen
Terry P
TP
Williamson
Janielee
J
Brant
Rollin
R
Mitton
Craig
C
Plint
Amy
A
Bulloch
Blake
B
Evered
Lisa
L
Johnson
David W
DW
D000284:Administration, Oral; D002675:Child, Preschool; D003440:Croup / Q000145:classification / Q000188:drug therapy* / Q000191:economics; D003907:Dexamethasone / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010290:Parents / Q000523:psychology; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012890:Sleep; D018709:Statistics, Nonparametric
D005938:Glucocorticoids; D003907:Dexamethasone