- Top of page
- Contributions of Authors
- Declarations of Interest
Croup is an illness characterized by barky cough, stridor, hoarseness, and occasionally respiratory distress. It is a relatively mild and short-lived illness for the majority of children. However, a small proportion of children have moderate to severe symptoms and are at risk of hospital admission, and in the most severe cases, intubation.
To synthesize the evidence currently in The Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup: glucocorticoids, epinephrine, heliox and humidified air.
The CDSR was searched for all systematic reviews containing the term ‘croup’ in the title. Pharmacologic and nonpharmacologic interventions for the treatment of croup in children were included. Data were extracted, compiled into tables and synthesized using qualitative and quantitative methods.
Four reviews examining the treatment of croup were included in this overview. Children treated with epinephrine vs placebo had a significantly lower croup score at 30 min (SMD: − 0.94; 95% CI: − 1.37, − 0.51), and children treated with glucocorticoids vs placebo had significantly lower croup scores at both 6 h and 12 h (SMD: − 0.59; 95% CI: − 0.83, − 0.35 and SMD: − 0.65; 95% CI: − 1.03, − 0.27). Glucocorticoids vs placebo also significantly reduced inpatient length of stay (MD: − 10.33; 95% CI: − 17.33, − 3.36) and risk of return visits and/or re-admissions (RR: 0.49; 95% CI: 0.34, 0.71). Neither humidified air nor heliox were associated with significant reductions in croup score; however, there is a paucity of evidence examining treatment with heliox.
Glucocorticoids are effective for children with mild croup, and both nebulized epinephrine and glucocorticoids are effective treatments for children presenting with moderate to severe croup that is associated with respiratory distress. There is insufficient evidence to determine the effectiveness of heliox, and there is sufficient evidence to suggest that humidified air is not effective in the treatment of croup. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration