The effectiveness of glucocorticoids in treating croup: meta-analysis

Objective To determine the effectiveness of glucocorticoid treatment in chi ldren with croup. Design Meta-analysis of randomized controlled trials that examine the effectiveness of glucocorticoid treatment in children with cro up. Main outcome measures Score on scale measuring severity of croup, use o f co-interventions (epinephrine, antibiotics, or supplemental glucocorticoi ds), length of stay in the emergency department or the hospital, and rate o f hospitalization. Results Twenty-four studies met the inclusion criteria. Glucocorticoid treatment was associated with an improvement in the croup se verity score at 6 hours with an effect size of -1.0 (95% confidence interva l [CI] -1.5 to -0.6) and at 12 hours -1.0 (-1.6 to -0.4); at 24 hours, this improvement was no longer significant (-1.0, -2.0 to -0.1). There was a de crease in the number of epinephrine treatments needed in children treated w ith glucocorticoids: a decrease of 9% (95% CI 2% to 16%) among those treate d with budesonide and of 12% (4% to 20%) among those treated with dexametha sone. There was also a decrease in the length of time spent in the emergenc y department (-11 hours, 95% CI -18 to 4 hours) and, for inpatients, hospit al stay was reduced by 16 hours (-31 to 1 hour). Publication bias seems to play a part in these results. Conclusions Dexamethasone and budesonide are effective in relieving the symptoms of croup as early as 6 hours after trea tment. Fewer co-interventions are used, and the length of time spent in the hospital is decreased in patients treated with glucocorticoids.