527 - Evaluation of Repeat Decadron Dosing in Children Admitted with Croup
Sunday, April 27, 2025
8:30am – 10:45am HST
Publication Number: 527.4580
Sheila Swartz, Medical College of Wisconsin, Menomonee Falls, WI, United States; Leah Cotter, Medical College of Wisconsin, Whitefish Bay, WI, United States; Brandon Palmer, Medical College of Wisconsin, Milwaukee, WI, United States; Gabriel M. Aguero, Medical College of Wisconsin, Wauwatosa, WI, United States; Jian Zhang, Medical College of Wisconsin, Milwaukee, WI, United States; Ke Yan, Medical College of Wisconsin, Milwaukee, WI, United States; Jennifer Hadjiev, Medical College of Wisconsin, Milwaukee, WI, United States
Assistant Professor Medical College of Wisconsin, Wisconsin, United States
Background: Croup is a common cause of respiratory distress in young children secondary to viral infection. Oral dexamethasone has been shown to improve the symptoms of respiratory distress caused by croup. The frequency of repeat dexamethasone dosing during admission or on discharge is not well understood, and the effect of re-dosing on readmission or recurrence of croup has not been well-established. Objective: Assess practice patterns in dexamethasone re-dosing and investigate the effect of re-dosing on readmission and recurrence of croup. Design/Methods: A retrospective cohort study of children ages 6 months to 7 years hospitalized with croup from 1/2013-1/2021. Exclusion criteria were direct admission to critical care, bacterial tracheitis, complex airway history, foreign body, congenital airway anomaly, vocal cord dysfunction, and treatment for asthma exacerbation. The main variable of interest was number of dexamethasone doses during admission or extra dosing on discharge. The primary outcome was re-admission or recurrence of croup symptoms following discharge. Results: A total of 485 children met inclusion criteria with 506 encounters. The median age was 17 (11, 25) months and the median LOS was 22 (16, 31) hours. During admission, 17% of children received no further dexamethasone, 66% received one dose, 9% received two doses, and 9% received three or more doses. 36% were prescribed dexamethasone at discharge. The readmission rate was 4% and recurrence without readmission was 8%. There was no significant difference in readmission or recurrence without admission for children who received discharge dexamethasone doses (p=0.23 and 0.99, respectively).
Conclusion(s): More than one-third of children were prescribed at least one discharge dose of dexamethasone which was not associated with a lower croup recurrence or readmission risk, suggesting this is not a useful intervention. Our study shows that there is likely an opportunity to decrease unnecessary interventions in children with croup, including discharge doses of dexamethasone.
