Effectiveness of a croup clinical pathway in the management of children with croup presenting to an emergency department

Authors

  • R Chin,

    1. Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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  • GJ Browne,

    1. Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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  • LT Lam,

    1. Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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  • ME McCaskill,

    1. Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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  • B Fasher,

    1. Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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  • J Hort

    1. Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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 Dr GJ Browne, Emergency Department, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Locked Bag 4001, Westmead, New South Wales 2145, Australia. Fax: + 61 2 9845 2468; email: GaryB@chw.edu.au

Abstract

Objective:  The aim of this study was to evaluate the safety and effectiveness of a clinical pathway for croup in an emergency department (ED).

Methodology:  This before-and-after intervention study on all consecutive children aged 6 months to 10 years who presented to our ED with moderate/severe croup was conducted over a 6-month period. Children with a clinical croup score (CSS) of 2 or more and resting stridor were considered eligible for entry into the study. Children were treated with either oral dexamethasone, or a combination of oral dexamethasone suspension and nebulized adrenaline. Children were clinically assessed, observed in the emergency short-stay ward and discharged or admitted according to the clinical pathway. The following outcomes were measured: admission rates, hospital re-presentation, length of stay, and adverse clinical events. Children in the post-intervention group were followed up by telephone within 48 h of discharge.

Results:  There were 157 patients recruited in the pre-intervention group and 110 in the post-intervention group. Significant reductions were reported in the length of stay (18.9 h compared with 5.2 h), hospital admission (52.9% compared with 18.0%) and intensive care admission (10.2% compared with 0.0%) after the introduction of the croup clinical pathway. No children in the study experienced an adverse clinical event. Follow-up interviews of parents indicated that the new treatment strategy was well received.

Conclusion:  The use of the croup clinical pathway in the ED is safe and effective in guiding consistent management, resulting in reduced admission rates, earlier discharge home, and no reported adverse events.

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