Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial

BMJ 1996;313:140-142 (20 July)

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Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial

G C Geelhoed, department director,^a J Turner, registrar,^a W B G Macdonald, consultant ^a

^a Emergency Department, Princess Margaret Hospital for Children, Box D184 GPO, Perth, WA 6001, Australia

Correspondence to: Dr Geelhoed.

Abstract

Objective: To assess the efficacy of a single dose of oral dexamethasone0.15 mg/kg in children with mild croup not admitted to hospital.
Design: Double blind, randomised, placebo controlled clinicaltrial.
Setting: The emergency department of a tertiary paediatric hospital.
Subjects: 100 children aged 4-122 months presenting with mildcroup.
Intervention: A single oral dose of dexamethasone 0.15 mg/kgor placebo.
Main outcome measure: Return to medical care with ongoing croup.
Results: Baseline characteristics of the two treatment groupswere similar. Eight children (all from the placebo group) returnedto medical care with ongoing croup, one being admitted. Therewas no reported difference in duration of croup symptoms, durationof viral symptoms, or rate of return to medical care for otherreasons.
Conclusion: Oral dexamethasone in a dose of 0.15 mg/kg is effectivein reducing return to medical care with ongoing croup in childrenwith mild croup.

Key messages

The benefits of steroids for children admitted to hospital are now well estab- lished
Most children with croup may be sent home, though up to one fifth may return with croup
A small single dose of oral dexamethasone (0.15 mg/kg) dramatically reduces the chance of reattending
All children presenting with croup should be considered for steroids

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