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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.

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Key studies 

Key study: Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study  (2016)

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

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  (2015)

Video: A barky, seal-like cough in children

Visit

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  (2013)

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, 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  (2013)

Key study: The comparison of oral and IM dexamethasone efficacy in croup treatment

Visit

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  (2012)

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

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  (2011)

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

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  (2010)

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

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  (2010)

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

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  (2007)

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

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  (2006)

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,

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  (2004)

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, 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  (2000)

Key Study: Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing

Visit

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  (1998)

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,

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  (1998)

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, 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  (1995)

Key Study: Oral and inhaled steroids in croup - A randomized, placebo-controlled trial

Visit

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  (1992)

Key Study: Placebo-controlled trial of prednisolone in children intubated for croup

Visit

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  (2016)

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

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  (2015)

Video: A barky, seal-like cough in children

Visit

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  (2013)

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, 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  (2013)

Key study: The comparison of oral and IM dexamethasone efficacy in croup treatment

Visit

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  (2012)

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

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  (2011)

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

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  (2010)

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

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  (2010)

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

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  (2007)

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

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  (2006)

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,

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  (2004)

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, 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  (2000)

Key Study: Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing

Visit

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  (1998)

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,

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  (1998)

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, 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  (1995)

Key Study: Oral and inhaled steroids in croup - A randomized, placebo-controlled trial

Visit

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  (1992)

Key Study: Placebo-controlled trial of prednisolone in children intubated for croup

Visit

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.


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