January 08, 2019
Glucocorticoids reduced the rate of hospital return visits and admissions compared with placebo in children with croup.
Children with croup who were administered glucocorticoids had reduced symptoms at 2 through 24 hours and lower rates of return hospital visits and admissions, according to a clinical analysis published in Annals of Emergency Medicine.
Researchers conducted the original meta-analysis by searching the Cochrane Central Register of Controlled Trials, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid MEDLINE, Ovid EMBASE, ClinicalTrials.gov, and the World Health Organization International Trials Registry Platform databases for randomized controlled trials of patients aged 0 to 18 years with a diagnosis of croup that compared outcomes of glucocorticoids to pharmacologic alternatives. Outcomes of interest were changes in croup score; return visits, admissions, or both; hospital length of stay, patient improvement, use of additional treatments, and adverse events.
Of the 79 initial search hits, 43 studies totaling 4565 patients were included in the analysis. Of these studies, 21 evaluated patients admitted to the emergency department, 21 evaluated hospitalized patients, and 1 evaluated patients who presented to an outpatient office.
Compared with placebo, glucocorticoids improved symptoms of croup at 2 hours (standardized mean difference –0.65; 95% CI, –1.13 to –0.18) through 24 hours (standardized mean difference, –0.86; 95% CI, –1.40 to –0.31). Furthermore, glucocorticoids also reduced the rate of hospital return visits and admissions compared with placebo (risk ratio, 0.52; 95% CI, 0.36-0.75). Most studies (98%) demonstrated high or unclear risk of bias. This determination was due to inadequate detail with regard to randomization and blinding methodology for many studies.
The review authors wrote, “With data from the 2005 National Hospital Ambulatory Medical Care Survey reporting that only 31% of children presenting to the emergency department with croup receive glucocorticoids, there exists a need for studies examining potential barriers to this intervention.”
April MD, Long B. Do glucocorticoids improve symptoms and reduce return visits or admission rates among children with croup? [published online December 7, 2019]. doi:10.1016/j.annemergmed.2018.10.030