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G498(P) Should a second dose of dexamethasone be given for the treatment of croup?

Background There have been several studies regarding the efficacy of dexamethasone in the treatment of croup but so far limited research regarding the benefits of multiple doses. Previous studies have recommended further study into the use of a second dose of dexamethasone for treatment.1 Local guidelines recommend a single dose of dexamethasone given in the Emergency Department and there has been discussion about discharging with a second dose of dexamethasone to be given twelve hours later. Aim To analyse the re-attendance rate to our Paediatric Emergency Department (PED) of patients treated with a single dose of dexamethasone for croup. To assess the clinical need for a second dose of dexamethasone in this cohort. Method Retrospective study of patients seen in our Paediatric Emergency Department who had been diagnosed with croup. 448 patients were identified over a 12 month period (January 2016 to December 2016). Results 406/448 patients were treated with a single dose of dexamethasone and discharged. 86% (350/406) of discharged patients did not re-attend. Of those discharged after a single dose dexamethasone 14% (56/406) re-attended. Of these 7% (29/406) were given a second dose of dexamethasone and discharged from PED. 1.5% (6/406) were admitted after a second dose was given in PED. 0.25% (1/406) was given additional therapies and admitted. 1% (5/406) required no additional therapies. 4% (15/406) had a change of diagnosis. Conclusion This review demonstrated an 86% success rate for the administration of a single dose of dexamethasone for the treatment of croup. In only 7% providing a second dose of dexamethasone to take home could have prevented a PED re-attendance. In a further 6%, attendance was necessary to either review the diagnosis or for admission due to deterioration. We therefore believe this large numbered review shows little benefit to providing a second dose of dexamethasone to take home and could even lead to a delay in either reviewing an incorrect diagnosis or being reviewed if deteriorating and requiring admission. Reference https://adc.bmj.com/content/100/Suppl_3/A40.2