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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.

BROWSE EVIDENCE REPOSITORY

 

Bottom Line Recommendations English (1) French (1) All (2)

Bottom Line Recommendations: Croup

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Johnson, DW. & TREKK Network

Bottom line recommendations for the treatment and management of croup.

Recommendations de Base: Laryngite Aigu

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Johnson, DW. & TREKK Network

Bottom line recommendations for the treatment and management of croup- French.

Bottom Line Recommendations: Croup

Download

Johnson, DW. & TREKK Network

Bottom line recommendations for the treatment and management of croup.

Recommendations de Base: Laryngite Aigu

Download

Johnson, DW. & TREKK Network

Bottom line recommendations for the treatment and management of croup- French.

Clinical guidelines English (4) French All (4)

BMJ Best Practice: Croup

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Bjornson C, Johnson DW,

Summary of Practice Guidelines for Croup.

Acute management of croup in the emergency department

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Ortiz-Alvarez O,

Acute management of croup in the emergency department.

Clinical Practice Guideline: Summary: Diagnosis and Management of Croup

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Albera Medical Association,

Summary of Alberta Clinical Practice Guideline document.

Clinical Practice Guideline: Guideline for the Diagnosis and Management of Croup

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Alberta Medical Association,

Developed by Alberta Clinical Practice Guideline Working Group.

BMJ Best Practice: Croup

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Bjornson C, Johnson DW,

Summary of Practice Guidelines for Croup.

Acute management of croup in the emergency department

Visit

Ortiz-Alvarez O,

Acute management of croup in the emergency department.

Clinical Practice Guideline: Summary: Diagnosis and Management of Croup

Visit

Albera Medical Association,

Summary of Alberta Clinical Practice Guideline document.

Clinical Practice Guideline: Guideline for the Diagnosis and Management of Croup

Visit

Alberta Medical Association,

Developed by Alberta Clinical Practice Guideline Working Group.

Summaries of systematic reviews English (4) French All (4)

Cochrane Summary: Glucocorticoids for croup in children

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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

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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

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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

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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

Visit

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

Visit

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

Visit

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

Visit

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.

Overviews of systematic reviews English (2) French All (2)

Cochrane Overview: Evidence Summary: Croup

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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

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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

Download

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

Visit

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.

Systematic reviews English (5) French All (5)

Cochrane Systematic Review: Glucocorticoids for croup in children

Visit

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

Visit

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

Visit

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

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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

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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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

Moore, M, Little, P,

Objective: To assess the efficacy of humidified air in the treatment of croup.

Key studies English (15) French All (15)

Key study: Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study

Visit

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.

Key study: The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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.

Key study: The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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

Visit

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.

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