Management and outcomes of patients presenting to the emergency department with croup: Can we identify which patients can safely be discharged from the emergency department?

ABSTRACT

AIM: Croup is a major cause of emergency department (ED) presentations, but there remains a paucity of evidence to guide clinical decision-making around which patients require admission. We aimed to describe the clinical characteristics, management and outcomes of patients presenting to the ED with croup and to identify characteristics associated with a need for further intervention. METHODS: We conducted a retrospective cohort study of all patients presenting to the ED of a tertiary paediatric hospital with croup between 2011 and 2016. Patients were included if they received two doses of nebulised adrenaline in the ED and were aged between 6 months and 6 years. Baseline characteristics, vital signs 2 h post-second dose of nebulised adrenaline, management and outcomes were recorded. RESULTS: A total of 5045 patients presented to ED with croup during the study period, 112 of whom received two doses of nebulised adrenaline within the ED. Of these patients, half were discharged home and half admitted to hospital. None of the discharged patients went on to require further intervention, and 19% of admitted patients received further interventions. Age and history of a chronic medical condition were associated with a need for further intervention. Of the vital signs, abnormal heart rate, fever and stridor were associated with a need for further intervention. CONCLUSIONS: Only 19% of patients admitted following two doses of nebulised adrenaline in the ED required further interventions. Older patients without a chronic medical condition who have a normal heart rate, temperature and no stridor may be suitable for outpatient management.