Abstract
Background
Croup is an inflammatory disease that affects the upper respiratory tract involving the upper airways of the lungs (bronchial tubes), vocal cords (larynx), and windpipe (trachea). In Canada, it is considered one of the major causes of respiratory diseases in the first 10 years of life. A wide range of viruses like common cold and flu (influenza) infections can cause croup (laryngotracheobronchitis). Dexamethasone has been commonly used to treat croup even though it lacks evidence on patients' recovery. The study aimed to compare the effect of the immediate or late dexamethasone administration on patient recovery and identify predictors for relapse among children with croup.
Methods
A retrospective cross-sectional study was conducted using the electronic medical record (Best Care) of all croup patients between 2014 and 2018 in King Abdullah Specialized Children's Hospital (KASCH), in Riyadh, Saudi Arabia. Out of the 329, only 186 patients matched our inclusion criteria. Statistical analysis was conducted with the SPSS V.22 software package (IBM Corp., Armonk, NY). The main outcome variable was early recovery or relapse. The chi-square test and logistic regression were used to assess the relationship between the independent variables with recovery or relapse among croup patients. A p-value of <0.05 was used to determine the significance of the test.
Results
Fifty-three recovered out of the 186 patients. Moreover, 50 of the recovered patients were treated in the ER. In addition, out of the 53 patients who recovered, 40 patients were treated as inpatients (IPs). Those who were given dexamethasone immediately for both recovery and relapsed groups were 29% and 71%, respectively while those who were given dexamethasone late were 34% for the recovery group. On the other hand, 119 patients relapsed. Out of those patients who relapsed, 111 were treated in the ER. Moreover, out of relapsed patients, 79 patients were treated as IPs. Furthermore, out of 186 patients, 86 had chronic illnesses. Twenty-four percent (24%) of those with chronic illnesses recovered, and 76% relapsed (P-value=0.04). Also, there was a significantly higher trend of administration of dexamethasone immediately in the ER in 69% of children with a p-value <0.001.
Conclusion
In conclusion, the difference between the early and late administration of dexamethasone in both recovery and relapse is not significant. Also, the presence of chronic illnesses affects relapses more significantly.