MANAGEMENT OF CROUP, CONTROVERSIES STILL EXIST.
The recent meta-analysis and the previous one strongly support
the use of glucocorticoids in croup. There are however considerable
unresolved issues including which glucocorticoid, what route and for how
We recently undertook a survey of 200 Paediatricians in 32 DGH (both
consultants and trainees) and asked their views on the management of
The response rate was 75 percent. Only 50 percent of units had a written
protocol. 126/152 used glucocorticoids for mild to moderate croup. Their
preferred steroid was oral dexamethasone(70), nebulised budesonide(42) and
oral prednisolone(14). 102/152 use a combination of oral and nebulised
steroids. 26/152 do not routinely use any form of glucocorticoids for the
management of croup. Of these 18 use nebulised adrenaline, 4 use mist
therapy and 4 just reassure and observe. The views of consultants(92) and
juniors(60) were equally diverse.
72/152 will admit a child with croup needing any form of treatment while
70/152 observe and send home if there is symptomatic improvement. Of
these 70, 38 will observe for 6 hours while the rest think a 2 to 4 hours
observation is sufficient. 10/152 were unsure.
This study highlights several important issues. There is good evidence
that glucocorticoids are helpful in the management of croup but the ideal
preparation, route and duration of administration remain unresolved. This
emphasises the need for further studies into the management of this common
condition, in order that evidence-based consensus guidelines can be
Croup is typical of many other paediatric conditions in which there is an
evidence base for management, but insufficient evidence to develop a
clinical protocol by which, under clinical governance, the management in
individual unit can be judged.
Specialist Registrar, Paediatrics,
Thorpe Rd. Peterborough PE3 6DA.
 Monica Ausejo,Antonio Saenz,James D Kelnar,David W Johnson,David
Moher, Terry P Klassen. "The Effectiveness Of Glucocorticoids in Treating
Croup", Meta-analysis .BMJ 4th September 1999.
 Kairy SW,Olmstead EM,OConner GT. "Steroid Treatment of
Laryngotracheo-bronchitis, meta-analysis of the evidence from randomised
trials", Paediatrics 1989, 83, p 683-93.
Competing interests: No competing interests