Failure of Outpatient Management With Different Observation Times After Racemic Epinephrine for Croup

Abstract

Background. Observation is necessary following racemic epinephrine (RE) for patients with croup. The ideal length of this observation period is unclear. Objective. To compare the rate of failed outpatient management utilizing different observation times after RE administration for croup. Methods. We performed a retrospective chart review of children with croup who required RE. Failure of treatment was defined as requiring a second RE treatment and/or returning to the pediatric emergency department for croup symptoms within 24 hours of discharge. Results. The primary analysis considered patients observed between 2.1 and 3 hours compared with those observed for 3.1 to 4 hours. The patients in the 2.1- to 3-hour group had a higher rate of treatment failure (16.7% vs 7.1%, OR = 2.44, P < .01). Conclusions. Patients requiring RE for croup are more likely to have treatment failure if observed for between 2.1 and 3 hours as opposed to 3.1 to 4 hours.