Pediatric emergency care · 2026
Using a Single Dose of Dexamethasone at 0.6 Versus 0.15 mg/kg of Body Weight for the Treatment of Croup: A Multicenter Retrospective Chart Review.
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Aregbesola Alex, Turnbull Jennifer, Oketola Banke, Plint Amy C, Badran Hoda, Gangwani Apoorva, Balshaw Robert, Klassen Terry P, Johnson David
Аннотация
OBJECTIVE: To compare the effectiveness and adverse events associated with treating children with croup with dexamethasone at 0.15 versus 0.6 mg/kg body weight.
METHODS: This retrospective cohort study included children (younger than 18 y) with a clinical diagnosis of croup in 4 pediatric emergency departments (EDs) between January 2017 and December 2019. The primary outcome was return visit to the ED for croup within 7 days, and the secondary outcomes were hospitalization within 7 days and occurrence of adverse events within 30 days. Both χ2 tests and logistic regression models were used to compare differences in the proportions of children with ED return visits, hospitalizations, and adverse events associated with dose.
RESULTS: We included 14,205 children in the final analysis. Of the 13,437 croup episodes from children treated with dexamethasone at 0.15 mg/kg (n=172) or 0.6 mg/kg (n=13,265), 2.9% and 4.1%, respectively, were ED return visits within 7 days following treatment. The difference in the proportion of ED return visits following treatment with the 2 doses was not statistically significant (1.2%; 95% CI: -1.31 to 3.76). In a multivariable-adjusted model, 0.15 mg/kg was not associated with ED return visits within 7 days [adjusted odds ratio (aOR)=0.88; 95% CI: 0.31-1.97], but was associated with hospitalization (aOR=3.18; 95% CI: 1.52-6.00). A total of 135 (1%) of all croup episodes had at least 1 adverse event within 30 days. Of those treated with 0.15 or 0.6 mg/kg, 1.2% and 1%, respectively, had at least 1 adverse event within 30 days. The most common adverse event was pneumonia (0.8%).
CONCLUSIONS: Our findings suggest that low-dose dexamethasone, 0.15 mg/kg, may be as effective as 0.6 mg/kg with comparable proportions of ED return visits and adverse events within 7 days. However, low-dose dexamethasone was associated with increased hospitalization. Clinicians should weigh the potential risk of hospitalization when choosing 0.15 mg/kg of dexamethasone.
METHODS: This retrospective cohort study included children (younger than 18 y) with a clinical diagnosis of croup in 4 pediatric emergency departments (EDs) between January 2017 and December 2019. The primary outcome was return visit to the ED for croup within 7 days, and the secondary outcomes were hospitalization within 7 days and occurrence of adverse events within 30 days. Both χ2 tests and logistic regression models were used to compare differences in the proportions of children with ED return visits, hospitalizations, and adverse events associated with dose.
RESULTS: We included 14,205 children in the final analysis. Of the 13,437 croup episodes from children treated with dexamethasone at 0.15 mg/kg (n=172) or 0.6 mg/kg (n=13,265), 2.9% and 4.1%, respectively, were ED return visits within 7 days following treatment. The difference in the proportion of ED return visits following treatment with the 2 doses was not statistically significant (1.2%; 95% CI: -1.31 to 3.76). In a multivariable-adjusted model, 0.15 mg/kg was not associated with ED return visits within 7 days [adjusted odds ratio (aOR)=0.88; 95% CI: 0.31-1.97], but was associated with hospitalization (aOR=3.18; 95% CI: 1.52-6.00). A total of 135 (1%) of all croup episodes had at least 1 adverse event within 30 days. Of those treated with 0.15 or 0.6 mg/kg, 1.2% and 1%, respectively, had at least 1 adverse event within 30 days. The most common adverse event was pneumonia (0.8%).
CONCLUSIONS: Our findings suggest that low-dose dexamethasone, 0.15 mg/kg, may be as effective as 0.6 mg/kg with comparable proportions of ED return visits and adverse events within 7 days. However, low-dose dexamethasone was associated with increased hospitalization. Clinicians should weigh the potential risk of hospitalization when choosing 0.15 mg/kg of dexamethasone.