Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department.
J Emerg Med
; 49(4): 408-14, 2015 Oct.
Article
em En
| MEDLINE
| ID: mdl-26242923
ABSTRACT
BACKGROUND:
Emergency department (ED) discharge is safe when croup-related stridor has resolved after corticosteroids and a single dose of racemic epinephrine (RE). Little evidence supports the traditional practice of hospital admission after ≥ 2 doses of RE.OBJECTIVE:
Our aim was to describe the frequency and timing of clinically important inpatient interventions after ≥ 2 ED RE doses.METHODS:
We identified patients hospitalized for croup after ED treatment with corticosteroids and ≥2 doses of RE. We compared asymptomatic (admitted solely on the number of RE doses) and symptomatic (admitted due to disease severity) groups with regard to inpatient RE administration, supplemental oxygen, helium-oxygen mixture (heliox) therapy, intubation, or transfer to a higher level of care, time to hospital discharge, and revisit and readmission rates within 48 h of discharge.RESULTS:
Of 200 subjects admitted after ≥ 2 ED RE doses, 72 (36%) received clinically important inpatientinterventions:
RE (n = 68 [34%]), heliox (n = 9 [5%]), and supplemental oxygen (n = 4 [2%]). Of patients who received inpatient RE, 53% received only 1 dose. No patients underwent intubation or transfer to higher level of care. The 112 asymptomatic patients had fewer interventions (14% vs. 63%; p < 0.001) and shorter hospital durations (14.5 vs. 22 h; p < 0.001). Only 14% of the asymptomatic group received RE, with 75% receiving a single dose. There were no differences in revisit and readmission rates.CONCLUSIONS:
Inpatient interventions after ≥ 2 ED doses of RE for croup were infrequent, most commonly RE administration. Most patients asymptomatic upon admission require 0-1 inpatient RE doses and may be candidates for outpatient management.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Broncodilatadores
/
Crupe
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Serviço Hospitalar de Emergência
/
Racepinefrina
Tipo de estudo:
Observational_studies
Limite:
Child, preschool
/
Female
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Humans
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Infant
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Male
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article