Context.— The effectiveness of glucocorticoids for patients with croup is well
established but it remains uncertain which glucocorticoid regimen is most
Objective.— To determine the effectiveness of 3 glucocorticoid regimens in patients
Design.— Randomized controlled trial with parallel design.
Setting.— Emergency departments of 2 Canadian pediatric tertiary care hospitals.
Participants.— Children with a clinical syndrome consistent with croup, aged 3 months
to 5 years, with a croup score of 2 or greater following at least 15 minutes
of mist therapy.
Interventions.— Oral dexamethasone, 0.6 mg/kg, and nebulized placebo; oral placebo and
nebulized budesonide, 2 mg; or oral dexamethasone, 0.6 mg/kg, and nebulized
budesonide, 2 mg.
Main Outcome Measures.— Westley croup score (primary outcome), hospital admission rates, time
spent in the emergency department, return visits to the emergency department,
or ongoing symptoms at 1 week.
Results.— The mean change in the croup score from baseline to the final study
assessment was −2.3 (95% confidence interval [CI], −2.6 to −2.0)
in the budesonide group (n=65), −2.4 (95% CI, −2.6 to −2.2)
in the dexamethasone group (n=69), and −2.4 (95% CI, −2.7 to −2.1)
in the budesonide and dexamethasone group (n=64, P=.70).
Conclusions.— Based on the similar outcomes in the 3 groups, oral dexamethasone is
the preferred intervention because of its ease of administration, lower cost,
and more widespread availability.