Croup is a common respiratory illness caused by a viral infection in the airway. Accompanied by a barky cough and respiratory distress, this illness is most common in children aged birth to 6 years, peaking at 2 years of age.
Bottom Line Recommendations: Croup
Johnson, DW. & TREKK Network
Johnson, DW. & TREKK Network
Bottom line recommendations for the treatment and management of croup.
Recommendations de Base: Laryngite Aigu
Johnson, DW. & TREKK Network
Johnson, DW. & TREKK Network
Bottom line recommendations for the treatment and management of croup- French.
Bottom Line Recommendations: Croup
Johnson, DW. & TREKK Network
Johnson, DW. & TREKK Network
Bottom line recommendations for the treatment and management of croup.
Recommendations de Base: Laryngite Aigu
Johnson, DW. & TREKK Network
Johnson, DW. & TREKK Network
Bottom line recommendations for the treatment and management of croup- French.
BMJ Best Practice: Croup
Bjornson C, Johnson DW,
Bjornson C, Johnson DW,
Summary of Practice Guidelines for Croup.
Acute management of croup in the emergency department
Ortiz-Alvarez O,
Ortiz-Alvarez O,
Acute management of croup in the emergency department.
BMJ Best Practice: Croup
Bjornson C, Johnson DW,
Bjornson C, Johnson DW,
Summary of Practice Guidelines for Croup.
Acute management of croup in the emergency department
Ortiz-Alvarez O,
Ortiz-Alvarez O,
Acute management of croup in the emergency department.
Cochrane Summary: Glucocorticoids for croup in children
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.
Cochrane Summary: Helium-oxygen (heliox) treatment for children with croup
Moraa I, Sturman N, McGuire TM, van Driel ML,
Moraa I, Sturman N, McGuire TM, van Driel ML,
Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.
Summary: Evidence for Clinicians: Nebulized epinephrine for croup in children
Kawaguchi A, Joffe A,
Kawaguchi A, Joffe A,
Expert commentary on the Cochrane Review on nebulized epinephrine for reducing symptoms in children with severe croup.
Cochrane Summary: Nebulized epinephrine for croup in children
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.
Cochrane Summary: Glucocorticoids for croup in children
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.
Cochrane Summary: Helium-oxygen (heliox) treatment for children with croup
Moraa I, Sturman N, McGuire TM, van Driel ML,
Moraa I, Sturman N, McGuire TM, van Driel ML,
Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.
Summary: Evidence for Clinicians: Nebulized epinephrine for croup in children
Kawaguchi A, Joffe A,
Kawaguchi A, Joffe A,
Expert commentary on the Cochrane Review on nebulized epinephrine for reducing symptoms in children with severe croup.
Cochrane Summary: Nebulized epinephrine for croup in children
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.
Cochrane Overview: Evidence Summary: Croup
Alberta Research Centre for Health Evidence (ARCHE),
Alberta Research Centre for Health Evidence (ARCHE),
The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews.
Cochrane Overview: The Cochrane Library and the treatment of croup in children: an overview of reviews
Bjornson, C, Russell, K, Foisy, M, Johnson, D,
Bjornson, C, Russell, K, Foisy, M, Johnson, D,
Objective: To synthesize the evidence currently in the Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup - glucocorticoids, epinephrine, heliox and humidified air.
Cochrane Overview: Evidence Summary: Croup
Alberta Research Centre for Health Evidence (ARCHE),
Alberta Research Centre for Health Evidence (ARCHE),
The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews.
Cochrane Overview: The Cochrane Library and the treatment of croup in children: an overview of reviews
Bjornson, C, Russell, K, Foisy, M, Johnson, D,
Bjornson, C, Russell, K, Foisy, M, Johnson, D,
Objective: To synthesize the evidence currently in the Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup - glucocorticoids, epinephrine, heliox and humidified air.
Cochrane Systematic Review: Glucocorticoids for croup in children
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years. Published: 2018.
Cochrane Systematic Review: Heliox for croup in children
Moraa I, Sturman N, McGuire TM, van Driel ML,
Moraa I, Sturman N, McGuire TM, van Driel ML,
Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.
Cochrane Systematic Review: Nebulized epinephrine for croup in children
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.
Review: Croup in children
Bjornson CL, Johnson DW,
Bjornson CL, Johnson DW,
Objective:This review will address the diagnosis and management of croup in children, specifically focusing on clinical assessment of disease severity to guide management decisions.
Cochrane Systematic Review: Humidified air inhalation for treating croup
Moore, M, Little, P,
Moore, M, Little, P,
Objective: To assess the efficacy of humidified air in the treatment of croup.
Cochrane Systematic Review: Glucocorticoids for croup in children
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,
Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years. Published: 2018.
Cochrane Systematic Review: Heliox for croup in children
Moraa I, Sturman N, McGuire TM, van Driel ML,
Moraa I, Sturman N, McGuire TM, van Driel ML,
Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.
Cochrane Systematic Review: Nebulized epinephrine for croup in children
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,
Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.
Review: Croup in children
Bjornson CL, Johnson DW,
Bjornson CL, Johnson DW,
Objective:This review will address the diagnosis and management of croup in children, specifically focusing on clinical assessment of disease severity to guide management decisions.
Cochrane Systematic Review: Humidified air inhalation for treating croup
Moore, M, Little, P,
Moore, M, Little, P,
Objective: To assess the efficacy of humidified air in the treatment of croup.
Key study: Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study
Eghbali A, Sabbagh A, Bagheri B, Taherahmadi H, Kahbazi M
Eghbali A, Sabbagh A, Bagheri B, Taherahmadi H, Kahbazi M
Objective: The objective of this study was to compare the effect of L-epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children.
Video: A barky, seal-like cough in children
Scott S, Hartling L, Klassen, T, Dyson M, Knisley L & Albrecht L
Scott S, Hartling L, Klassen, T, Dyson M, Knisley L & Albrecht L
Croup is a common respiratory illness caused by a viral infection in the airways. Accompanied by a barky cough and respiratory distress, this illness is most common in children from birth to 6 years of age, peaking at 2 years of age. This is a short, animated video about signs and symptoms of croup, and what to do if you are a parent or a family dealing with a child who has croup. This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Canadian Institutes of Health Research (CIHR).
Key study: The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial
Garbutt JM, Conlon B, Sterkel R, Baty J, Schechtman KB, Mandrell K, Leege E, Gentry S, Stunk RC
Garbutt JM, Conlon B, Sterkel R, Baty J, Schechtman KB, Mandrell K, Leege E, ...
Objective: Our objective was to compare the effectiveness of prednisolone 2 mg/kg for 3 days, a treatment regimen already commonly prescribed by pediatricians in our community; with one dose of dexamethasone 0.6 mg/kg, a treatment regimen known to be effective in the ED setting, for children with mild or moderate croup diagnosed at an office visit.
Key study: The comparison of oral and IM dexamethasone efficacy in croup treatment
Soleimani G, Daryadel A, Ansari Moghadam A, Sharif MR
Soleimani G, Daryadel A, Ansari Moghadam A, Sharif MR
Objective: In this study, the efficacies of intramuscular and oral dexamethasone administration are compared for treatment of croup.
Key study: How fast does oral dexamethasone work in mild to moderately severe croup? A randomized double-blinded clinical trial
Dobrovoljac M, Geelhoed GC
Dobrovoljac M, Geelhoed GC
Objective: For children with croup controversy remains over dosage and time to onset of action of oral steroids. The Cochrane Collaboration and other reviews have suggested 0.6 mg/kg dexamethasone be used (despite some evidence that 0.15 mg/kg is effective) with no expectation of benefit before 4-6 h. This randomized double-blinded clinical trial examines whether 0.15 mg/kg dexamethasone works by 30 min. Published: 2012.
Key study: Seasonality patterns in croup presentations to emergency departments in Alberta, Canada: a time series analysis
Rosychuk RJ, Klassen TP, Voaklander DC, Senthilselvan A, Rowe BH
Rosychuk RJ, Klassen TP, Voaklander DC, Senthilselvan A, Rowe BH
Objective: We examine the monthly patterns of young children who made croup-related visits to EDs in Alberta, Canada.
Key study: The effectiveness of local corticosteroids therapy in the management of mild to moderate viral croup
Eboriadou M, Chryssanthopoulou D, Stamoulis P, Damianidou L, Haidopoulou K
Eboriadou M, Chryssanthopoulou D, Stamoulis P, Damianidou L, Haidopoulou K
Objective: The purpose of this study was to determine whether local anti-inflammatory therapy with inhaled beclomethasone dipropionate is effective in the outpatient management of acute viral croup.
Key study: Croup presentations to emergency departments in Alberta, Canada: a large population-based study
Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH
Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH
Objective: The objective of this study was to describe the epidemiology of croup presentations to EDs made by infants (
Key study: A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup
Chub-Uppakarn S, Sangsupawanich P
Chub-Uppakarn S, Sangsupawanich P
Objective: The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.
Key Study: Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial
Scolnik, D, Coates, AL, Stephens, D, Da Silva, Z, Lavine, E, Schuh, S,
Scolnik, D, Coates, AL, Stephens, D, Da Silva, Z, Lavine, E, Schuh, S,
Objective: To determine whether a significant difference in the clinical Westley croup score exists in children with moderate to severe croup who were admitted to the emergency department and who received either 100% humidity or 40% humidity via nebulizer or blow-by humidity.
Key Study: A randomized trial of a single dose of oral dexamethasone for mild croup
Bjornson, CL, Klassen, TP, Williamson, J, Brant, R, Mitton, C, Plint, A, Bulloch, B, Evered, L, Johnson, DW,
Bjornson, CL, Klassen, TP, Williamson, J, Brant, R, Mitton, C, Plint, A, Bull...
Objective: The primary outcome was a return to a medical care provider for croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child's illness.
Key Study: Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing
Rittichier, KK, Ledwith, CA,
Rittichier, KK, Ledwith, CA,
Objective: Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study.
Key Study: A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup
Johnson, DW, Jacobson, S, Edney, PC, Hadfield, P, Mundy, ME, Schuh, S,
Johnson, DW, Jacobson, S, Edney, PC, Hadfield, P, Mundy, ME, Schuh, S,
Objective: To study how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization.
Key Study: Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial
Klassen, TP, Craig, WR, Moher, D, Osmond, MH, Pasterkamp, H, Sutcliffe, T, Watters, LK, Rowe, PC,
Klassen, TP, Craig, WR, Moher, D, Osmond, MH, Pasterkamp, H, Sutcliffe, T, Wa...
Objective: To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.
Key Study: Oral and inhaled steroids in croup - A randomized, placebo-controlled trial
Geelhoed, GC, Macdonald, WB,
Geelhoed, GC, Macdonald, WB,
Objective: To compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design.
Key Study: Placebo-controlled trial of prednisolone in children intubated for croup
Tibballs, J, Shann, FA, Landau, LI,
Tibballs, J, Shann, FA, Landau, LI,
Objective: To study the effect of prednisolone on two clinical endpoints--the duration of intubation and the need for reintubation.
Key study: Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study
Eghbali A, Sabbagh A, Bagheri B, Taherahmadi H, Kahbazi M
Eghbali A, Sabbagh A, Bagheri B, Taherahmadi H, Kahbazi M
Objective: The objective of this study was to compare the effect of L-epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children.
Video: A barky, seal-like cough in children
Scott S, Hartling L, Klassen, T, Dyson M, Knisley L & Albrecht L
Scott S, Hartling L, Klassen, T, Dyson M, Knisley L & Albrecht L
Croup is a common respiratory illness caused by a viral infection in the airways. Accompanied by a barky cough and respiratory distress, this illness is most common in children from birth to 6 years of age, peaking at 2 years of age. This is a short, animated video about signs and symptoms of croup, and what to do if you are a parent or a family dealing with a child who has croup. This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Canadian Institutes of Health Research (CIHR).
Key study: The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial
Garbutt JM, Conlon B, Sterkel R, Baty J, Schechtman KB, Mandrell K, Leege E, Gentry S, Stunk RC
Garbutt JM, Conlon B, Sterkel R, Baty J, Schechtman KB, Mandrell K, Leege E, ...
Objective: Our objective was to compare the effectiveness of prednisolone 2 mg/kg for 3 days, a treatment regimen already commonly prescribed by pediatricians in our community; with one dose of dexamethasone 0.6 mg/kg, a treatment regimen known to be effective in the ED setting, for children with mild or moderate croup diagnosed at an office visit.
Key study: The comparison of oral and IM dexamethasone efficacy in croup treatment
Soleimani G, Daryadel A, Ansari Moghadam A, Sharif MR
Soleimani G, Daryadel A, Ansari Moghadam A, Sharif MR
Objective: In this study, the efficacies of intramuscular and oral dexamethasone administration are compared for treatment of croup.
Key study: How fast does oral dexamethasone work in mild to moderately severe croup? A randomized double-blinded clinical trial
Dobrovoljac M, Geelhoed GC
Dobrovoljac M, Geelhoed GC
Objective: For children with croup controversy remains over dosage and time to onset of action of oral steroids. The Cochrane Collaboration and other reviews have suggested 0.6 mg/kg dexamethasone be used (despite some evidence that 0.15 mg/kg is effective) with no expectation of benefit before 4-6 h. This randomized double-blinded clinical trial examines whether 0.15 mg/kg dexamethasone works by 30 min. Published: 2012.
Key study: Seasonality patterns in croup presentations to emergency departments in Alberta, Canada: a time series analysis
Rosychuk RJ, Klassen TP, Voaklander DC, Senthilselvan A, Rowe BH
Rosychuk RJ, Klassen TP, Voaklander DC, Senthilselvan A, Rowe BH
Objective: We examine the monthly patterns of young children who made croup-related visits to EDs in Alberta, Canada.
Key study: The effectiveness of local corticosteroids therapy in the management of mild to moderate viral croup
Eboriadou M, Chryssanthopoulou D, Stamoulis P, Damianidou L, Haidopoulou K
Eboriadou M, Chryssanthopoulou D, Stamoulis P, Damianidou L, Haidopoulou K
Objective: The purpose of this study was to determine whether local anti-inflammatory therapy with inhaled beclomethasone dipropionate is effective in the outpatient management of acute viral croup.
Key study: Croup presentations to emergency departments in Alberta, Canada: a large population-based study
Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH
Rosychuk RJ, Klassen TP, Metes D, Voaklander DC, Senthilselvan A, Rowe BH
Objective: The objective of this study was to describe the epidemiology of croup presentations to EDs made by infants (
Key study: A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup
Chub-Uppakarn S, Sangsupawanich P
Chub-Uppakarn S, Sangsupawanich P
Objective: The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.
Key Study: Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial
Scolnik, D, Coates, AL, Stephens, D, Da Silva, Z, Lavine, E, Schuh, S,
Scolnik, D, Coates, AL, Stephens, D, Da Silva, Z, Lavine, E, Schuh, S,
Objective: To determine whether a significant difference in the clinical Westley croup score exists in children with moderate to severe croup who were admitted to the emergency department and who received either 100% humidity or 40% humidity via nebulizer or blow-by humidity.
Key Study: A randomized trial of a single dose of oral dexamethasone for mild croup
Bjornson, CL, Klassen, TP, Williamson, J, Brant, R, Mitton, C, Plint, A, Bulloch, B, Evered, L, Johnson, DW,
Bjornson, CL, Klassen, TP, Williamson, J, Brant, R, Mitton, C, Plint, A, Bull...
Objective: The primary outcome was a return to a medical care provider for croup within seven days after treatment. The secondary outcome was the presence of ongoing symptoms of croup on days 1, 2, and 3 after treatment. Other outcomes included economic costs, hours of sleep lost by the child, and stress on the part of the parent in relation to the child's illness.
Key Study: Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing
Rittichier, KK, Ledwith, CA,
Rittichier, KK, Ledwith, CA,
Objective: Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study.
Key Study: A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup
Johnson, DW, Jacobson, S, Edney, PC, Hadfield, P, Mundy, ME, Schuh, S,
Johnson, DW, Jacobson, S, Edney, PC, Hadfield, P, Mundy, ME, Schuh, S,
Objective: To study how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization.
Key Study: Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial
Klassen, TP, Craig, WR, Moher, D, Osmond, MH, Pasterkamp, H, Sutcliffe, T, Watters, LK, Rowe, PC,
Klassen, TP, Craig, WR, Moher, D, Osmond, MH, Pasterkamp, H, Sutcliffe, T, Wa...
Objective: To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.
Key Study: Oral and inhaled steroids in croup - A randomized, placebo-controlled trial
Geelhoed, GC, Macdonald, WB,
Geelhoed, GC, Macdonald, WB,
Objective: To compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design.
Key Study: Placebo-controlled trial of prednisolone in children intubated for croup
Tibballs, J, Shann, FA, Landau, LI,
Tibballs, J, Shann, FA, Landau, LI,
Objective: To study the effect of prednisolone on two clinical endpoints--the duration of intubation and the need for reintubation.