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The effectiveness of glucocorticoids in treating croup: meta-analysis

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7210.595 (Published 04 September 1999) Cite this as: BMJ 1999;319:595

The effectiveness of glucocorticosteroids in treating croup

EDITOR

The meta-analysis by Ausejo et al is certainly timely as the
croup season approaches 1.Despite the usefullness of corticosteroids
having been recognised for many years our experience is that children
rarely receive this treatment in any form before admission to hospital.

Geelhoed et al showed the benefit of a small single dose of dexamethasone
for out-patient croup in 1996 2. and Godden et al confirmed the
usefullness of nebulised budesonide 3 but there still appears to be a
reluctance to treat mild croup despite the reduction in symptoms which
untreated usually last 3-4 days.

Our review of the casenotes of children
admitted with croup between November 1996 and October 1997 identified 51
cases in a total paediatric population of 65 000. GP referrals accounted
for 60% admissions [31/51] and none of these children had received either
inhaled or systemic steroid apart from one child seen at a primary care
casualty department who received hydrocortisone. Although formal croup
scores were not recorded on admission, the majority of cases were mild and
90% [46/51] were discharged within 16 hours of admission i.e. the
following morning if admitted at night, or the same day if admitted in the
early hours.The duration of cough was greater than 8 hours in 55 % cases
which suggests a window of opportunity for treatment if parents are
encouraged to seek help. As discussed by Thomson2 in her commentary,
dexamethasone is cheap, easier to administer and as effective as nebulised
corticosteroids and perhaps should be added to the list of black bag
essentials - albeit that the major determinant of treatment or indeed
admission to hospital, may be the degree of parental anxiety generated by
caring for a stridulous child in the middle of the night.

Angela J Tillett
specialist registrar in paediatrics

Department of Paediatrics, Addenbrooke's NHS Trust, Hills Road, Cambridge
CB2 2QQ

James D M Gould
consultant paediatrician

Department Child Health, Ipswich Hospital NHS Trust, Heath Road, Ipswich
IP4 5PD

1. Ausejo M, Saenz A, Ba'Pham, Kellner J, Johnson D, Moher D and
Klassen T The effectiveness of glucocorticosteroids in treating croup:
meta-analysis BMJ 1999:319:595-600

2. Geelhoed G, Turner J and Macdonald W. Efficacy of a small single
dose of oral dexamethasone for outpatient croup: a double blind placebo
controlled trial BMJ 1996; 313:140-2

3. Godden C, Campbell M, Hussey M and Cogswell J . Double blind
placebo controlled trial of nebulised budesonide for croup Arch Dis Child
1997;76: 155-158

Competing interests: No competing interests

06 October 1999
Angela J Tillett