title: Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department.
abstract: BACKGROUND
  Emergency department (ED) discharge is safe when croup-related stridor has resolved after corticosteroids and a single dose of racemic epinephrine (RE). Little evidence supports the traditional practice of hospital admission after ≥ 2 doses of RE.
  
  
  OBJECTIVE
  Our aim was to describe the frequency and timing of clinically important inpatient interventions after ≥ 2 ED RE doses.
  
  
  METHODS
  We identified patients hospitalized for croup after ED treatment with corticosteroids and ≥2 doses of RE. We compared asymptomatic (admitted solely on the number of RE doses) and symptomatic (admitted due to disease severity) groups with regard to inpatient RE administration, supplemental oxygen, helium-oxygen mixture (heliox) therapy, intubation, or transfer to a higher level of care, time to hospital discharge, and revisit and readmission rates within 48 h of discharge.
  
  
  RESULTS
  Of 200 subjects admitted after ≥ 2 ED RE doses, 72 (36%) received clinically important inpatient interventions: RE (n = 68 [34%]), heliox (n = 9 [5%]), and supplemental oxygen (n = 4 [2%]). Of patients who received inpatient RE, 53% received only 1 dose. No patients underwent intubation or transfer to higher level of care. The 112 asymptomatic patients had fewer interventions (14% vs. 63%; p < 0.001) and shorter hospital durations (14.5 vs. 22 h; p < 0.001). Only 14% of the asymptomatic group received RE, with 75% receiving a single dose. There were no differences in revisit and readmission rates.
  
  
  CONCLUSIONS
  Inpatient interventions after ≥ 2 ED doses of RE for croup were infrequent, most commonly RE administration. Most patients asymptomatic upon admission require 0-1 inpatient RE doses and may be candidates for outpatient management.
authors.affiliation: Division of Emergency Medicine, Rady Children's Hospital San Diego, San Diego, California; Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Rudinsky
authors.affiliation: Division of Emergency Medicine, Rady Children's Hospital San Diego, San Diego, California; Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California.
authors.forename: Ghazala Q
authors.initials: GQ
authors.lastname: Sharieff
authors.affiliation: Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California.
authors.forename: Whitney
authors.initials: W
authors.lastname: Law
authors.affiliation: Division of Emergency Medicine, Rady Children's Hospital San Diego, San Diego, California; Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California.
authors.forename: John T
authors.initials: JT
authors.lastname: Kanegaye
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D010100:Oxygen / Q000008:administration & dosage; D010359:Patient Readmission / Q000706:statistics & numerical data; D064705:Racepinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D012135:Respiratory Sounds / Q000187:drug effects; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D064705:Racepinephrine; D010100:Oxygen
keywords: adverse reaction; croup; drug-related side effects; racepinephrine