Community Care for Croup (RCT)

Phase 4

Completed

Brief Summary: This randomized clinical trial was to compare the effectiveness of prednisone 2mg/kg/day for 3 days vs. dexamethasone 0.6mg/kg for 1 day for treatment of children with mild or moderate croup. It was conducted in a practice-based research network of community pediatricians in the St. Louis area. Outcomes included additional health care for croup, duration of symptoms, nights of disturbed sleep, parental stress, missed work days, and adverse events. Our hypothesis was that community-based treatment of children with mild or moderate croup with multiple doses of prednisone is superior to a single dose of dexamethasone.

Recruitment & Eligibility

Inclusion Criteria

children aged 1 to 8 years old (not yet reached their 9th birthday), who have croup symptoms for less than or equal to 48 hours and have a physician diagnosis of mild or moderate croup.

Exclusion Criteria

Severe croup or impending respiratory failure;
another reason to indicate the need for hospitalization;
symptoms or signs to suggest another cause of stridor;
active varicella infection;
diabetes;
known immunodeficiency disease;
chronic respiratory disease such as CF (Cystic Fibrosis);
prescribed a controller medication or oral steroids for asthma in the past 12 months;
a history of TB(tuberculosis) in a household member;
treatment for seizures;
treatment with epinephrine or oral corticosteroids for this croup episode before enrollment;
not accompanied by their legal guardian;
the accompanying adult will not be in the same household as the child for the next four days;
parent/legal guardian is unavailable for telephone follow-up or does not speak English.

Arm && Interventions

Group	Intervention	Description
Prednisone	Prednisone	Prednisone, 2mg/kg for 3 days
Dexamethasone	Dexamethasone	Dexamethasone, 0.6mg/kg for one day, then placebo for 2 days

Primary Outcome Measures

Name	Time	Method
Additional Health Care	11 days	The primary outcome was the % of participants who had additional health care for croup within 11 days of randomization assessed by self-report. This dichotomous variable was positive if any of the following occurred: office visit, ED visit or hospitalization for croup care.

Secondary Outcome Measures

Name	Time	Method
Duration of Croup Symptoms	12 days
Nights With Disturbed Sleep	12 days
Parental Stress	12 days	Parental stress due to the child's illness was rated using a 4-point categorical scale (ranging from 3-very stressed to 0-not stressed). We report days until the stress rating was 0.
Time Missed From Work	12 days
Number of Participants With Reported Side Effects	12 days