Evaluation of Repeat Steroid Dosing in Children Admitted With Croup

OBJECTIVE: Croup is a common cause of respiratory distress in young children due to airway obstruction from laryngeal edema secondary to viral upper respiratory infection. Our goal was to measure the effect of redosing steroids on the length of stay (LOS) and rates of recurrence of croup symptoms in children hospitalized with uncomplicated croup. PATIENTS AND METHODS: Non-critically ill children hospitalized with croup from 2013 to 2021 were identified using encounter diagnosis codes. Variables including demographic factors, total dexamethasone dose given during hospitalization or within 24 hours of admission, dexamethasone prescribed at discharge, LOS, and recurrence or readmission were obtained by chart review. The Bedside Pediatric Early Warning System score was used to quantify the degree of illness. RESULTS: A total of 486 children were included in the study; 188 (39%) got more than 1 dose of dexamethasone during admission, and 160 (33%) received a prescription for dexamethasone on discharge. Fifty-eight children (12%) had recurrence of symptoms after hospital discharge. Recurrence of symptoms was not associated with total dexamethasone dose administered in the hospital or prescription of a dexamethasone at discharge. When controlling for degree of illness, administration of more than 1 dose of dexamethasone was associated with a 55% longer LOS. DISCUSSION: Repeated steroid dosing in non-critically ill children admitted with croup is associated with an increased LOS without improving readmission or recurrence outcomes even when controlling for degree of illness, although this finding may be driven by immortal time bias or confounding by indication.