Author's reply

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7029.510d (Published 24 February 1996) Cite this as: BMJ 1996;312:510
  1. Iolo Doull
  1. Senior registrar in paediatric intensive care Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH

    EDITOR,—P I Macfarlane and S Suri question both the validation of croup scores and the scores' usefulness. They do not, however, mention what they consider to be a more appropriate measure of croup. The Syracuse croup score has been validated on the need to admit a patient to an intensive therapy unit.1 In the absence of a more objective measure, croup scores (flawed as they are) are the only measure available. Moreover, croup scores are useful in hospital clinical practice. As most croup presents outside normal working hours, croup scores are useful to junior paediatricians as a reminder of assessment criteria and as a measure of severity.

    M Cronin and R Diedericks express concern that I did not refer to nebulised adrenaline. As the title of my editorial made clear, my primary aim was to draw attention to the role of corticosteroids in croup. The one trial comparing nebulised adrenaline with nebulised corticosteroids showed broadly similar effects, although, as it is reported only in abstract form, interpretation must be limited (D Fitzgerald et al, meeting of Australian Thoracic Society, March 1995). Although nebulised adrenaline clearly has a role in the management of croup, I believe that it has no role in mild to moderate croup and (with rare exceptions) should not be used in the community. The role of nebulised adrenaline is to avert or delay the need for intubation, and consequently it should be used only under controlled conditions. Relapse after the use of nebulised adrenaline is well described—indeed, in the study that Cronin and Kiedericks cite, by Kristjansson et al, over a third of the children receiving adrenaline relapsed, and the authors recommended that children receiving adrenaline should be observed for two hours. I believe that children who require nebulised adrenaline should be observed where facilities are available for urgent intubation should the need arise.


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