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respiratory
paediatric
clinical skills
treatment

A critical analysis and appraisal of the management of croup in the UK out-of-hospital environment

02 June 2015
Features
02 June 2015
Volume 7 · Issue 6

Abstract

This article aims to explore the epidemiology, aetiology and pathophysiology of laryngotracheobronchitis (croup), a commonly presenting illness faced by paramedics attending young children in the community. In this article, current evidence surrounding pharmacotherapies for croup shall be discussed with relevance to paramedic practice. Furthermore, current dosages, routes of administration, cost-effectiveness and weight-based drug calculations will be outlined and debated alongside the current evidence base.

This is a critical analysis and appraisal of the evidence base surrounding the treatment and management of laryngotracheobronchitis (croup) in children. In this analysis, particular focus shall be given to existing evidence comparing current pharmacotherapies, while also exploring the cost-effectiveness of such treatment strategies, in order to provide recommendations for paramedic practice.

Croup is a common respiratory infection with an incidence of around 3% of the paediatric population per year, most commonly affecting children between 6–36 months and more commonly males than females (Johnson, 2009; Brashers and Huether, 2014). The prevalence within this age group is commonly thought to be due to socialisation of the child in nurseries and schools, with additional predisposing factors such as pollution, passive smoking and immunological immaturity being noted (Mansi et al, 2009). In addition, a general consensus in the literature identifies a seasonal variance in the prevalence of croup, with a peak in patient presentations to health services in late spring/autumn to winter months, with the opposite being true for summer months (Segal et al, 2005; D'Souza et al, 2007; Bjornson and Johnson, 2008; Rihkanen et al, 2008). This is also supported by Public Health England (2014), who show that activity of one of the dominant causative agents for croup, the human parainfluenza virus (HPIV) is greatest in autumn and winter months.

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Croup
Corticosteroid
Children
Dexamethasone
Laryngotracheobronchitis
Paediatric