Journal Watch Emergency Medicine
January 29, 2003
Steroids for Croup: Put Away Those Needles!

from Journal Watch
Physician-authored summaries and commentary
from the publishers of the New England Journal
of Medicine

Posted 02/18/2003


Summary

Intramuscular dexamethasone ameliorates croup, which is usually a several-day illness characterized by long nights of incessant, barking cough. The authors of this study compared IM and oral administration of dexamethasone in children with moderate-to-severe croup.

In a prospective, randomized, double-blind trial, 95 children aged 3 to 84 months with a Westley croup score of 2 or greater received either 0.6-mg/kg IM dexamethasone plus oral placebo or 0.6-mg/kg oral dexamethasone plus a sham injection. All patients were treated with cool mist therapy for 10 to 15 minutes. Parents were questioned by telephone approximately 24 hours and 10 days after the initial visit. At those intervals, there were no statistically significant differences between groups in the proportion of patients with barking cough, stridor, expiratory sounds, sleep pattern, degree of improvement, or complete resolution of symptoms.
Comment

For any parent who has spent several sleepless nights with a child who has croup, steroids are heaven-sent. IM dexamethasone, however, involves giving children what they fear most -- a shot. This study shows that oral dexamethasone is as effective as IM dexamethasone, so the oral route is a win-win for everyone.

— Diane M. Birnbaumer, MD, FACEP
Source

Donaldson D et al. Intramuscular versus oral dexamethasone for the treatment of moderate-to-severe croup: A randomized, double-blind trial. Acad Emerg Med 2003 Jan; 10:16-21.