Croup management in Australia and New Zealand: a PREDICT study of physician practice and clinical practice guidelines.
OBJECTIVE
Comparison of clinical practice guideline (CPG) recommendations and reported physician management of croup at PREDICT (Paediatric Research in Emergency Departments International Collaborative) sites as baseline for planned randomized controlled trials.


METHODS
Review of CPGs for croup from PREDICT sites and survey of specialist pediatric emergency physicians regarding croup management. PREDICT sites included 8 tertiary pediatric hospitals and 3 large mixed emergency departments in Australia and New Zealand.


RESULTS
Nine of the 11 sites had a CPG for croup. Response rate was 94% (78/83). Adrenaline was recommended for moderate croup (3%), severe croup (52%), and life-threatening croup by (100%). Steroid therapy was recommended for mild croup (45%), for moderate croup (97%), for severe croup (97%), and for life-threatening croup (96%). Steroid choice was oral dexamethasone (60%) and oral prednisolone (38%). In severe croup, 77% used intravenous/intramuscular dexamethasone, 10% used intravenous/intramuscular methylprednisolone, and 8% used nebulized budesonide. Commonest dosage regimens were 0.15 mg/kg dexamethasone or 1 mg/kg prednisolone. A standard volume dosage regimen for nebulized adrenaline was used by 54%, whereas 39% used a weight-based formula. Clinical practice guidelines recommended 5 mg (11%) or 10 mg (33%) for standard volume dosing, and all CPGs using weight-based dosing recommend 0.5 mg/kg with maximum doses ranging from 5 to 15 mg.


CONCLUSIONS
Croup management at PREDICT emergency departments is similar, based on oral steroids and nebulized adrenaline. The steroid and adrenaline regimens used by respondents and their CPGs were not consistent. This reflects limitations of available evidence for management of this common disease, highlighting the need for definitive trials, particularly in the management of mild croup.
Borland
Meredith Louise
ML
Princess Margaret Hospital, Subiaco, Western Australia. Meredith.Borland@health.wa.gov.au
Babl
Franz E
FE
Sheriff
Nisa
N
Esson
Amanda Doreen
AD
D001315:Australia; D002648:Child; D003440:Croup / Q000145:classification / Q000188:drug therapy*; D003907:Dexamethasone / Q000627:therapeutic use*; D004635:Emergency Medicine; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D009520:New Zealand; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone; D004837:Epinephrine