Croup: the steroid saga

13 January, 2011 by: colinparker

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Dex or Pred? What dose? Grandmaster G helps us navigate the steroid evolution of the last couple of decades. We’re almost there, just one big RCT until we know the answer!

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Steroids for Croup

Introduction & disclaimer
History – steroids introduction

[GG] initial disbelief in steroids for croup

[SF] Pred for intubated patients – Tibballs Lancet 1992

[CP] Geelhoed 1995 dex vs budesonide vs placebo

[CP] Geelhoed GC, Macdonald WB. 1995 0.6 vs 0.3 vs 0.15 (dose-finding)

[CP] Geelhoed 1996 (BMJ) dex 0.15 vs placebo for mild croup (outpatient)

[KB] Geelhoed 1996 (Annals Emerg Med): Sixteen years’ experience

[CP] Latest Cochrane review: Russell 2004 (Jan)
31 studies included, N=3736
Steroids work within 6 hrs and decrease admission, length of stay, return visits
Implications for research: optimal dose dex needs to be defined (0.15 vs 0.6); dissemination of evidence / physician uptake

[CP] PECARN Bjornson 2004 (Sept)
dex 0.6mg/kg vs placebo! N=720
Representation rate halved from 15 to 7 percent, less stress for parents

Pred vs Dex papers

[SF] Sparrow  2005 (n=133)

[KB] Alison Fifoot & Joseph Ting EMA 2007 (n=99)

[SF] 2009 Milana & Gary 27 yrs’ experience: progress paper

[CP] Dose of dex finally settled?
bestBET Port 2009
but Review in NEJM 2008 by James Cherry still recommends dex 0.6

[CP] Introduction to ToPDoG study
Aiming to recruit 3 x 437 subjects
Details on ANZCTR website

New directions

[KB] ?heliox

[SF] Coronavirus – a newly identified pathogen

[CP] ?paraflu vaccine

[all] Summary / pearls

[CP] Thanks to Gary

[all] Goodbye & Begood

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