Using a Single Dose of Dexamethasone at 0.6 Versus 0.15 mg/kg of Body Weight for the Treatment of Croup

Objective: To compare the effectiveness and adverse events associated with treating children with croup with dexamethasone at 0.15 versus 0.6 mg/kg body weight. Methods: This retrospective cohort study included children (younger than 18 y) with a clinical diagnosis of croup in 4 pediatric emergency departments (EDs) between January 2017 and December 2019. The primary outcome was return visit to the ED for croup within 7 days, and the secondary outcomes were hospitalization within 7 days and occurrence of adverse events within 30 days. Both χ 2 tests and logistic regression models were used to compare differences in the proportions of children with ED return visits, hospitalizations, and adverse events associated with dose. Results: We included 14,205 children in the final analysis. Of the 13,437 croup episodes from children treated with dexamethasone at 0.15 mg/kg (n=172) or 0.6 mg/kg (n=13,265), 2.9% and 4.1%, respectively, were ED return visits within 7 days following treatment. The difference in the proportion of ED return visits following treatment with the 2 doses was not statistically significant (1.2%; 95% CI: −1.31 to 3.76). In a multivariable-adjusted model, 0.15 mg/kg was not associated with ED return visits within 7 days [adjusted odds ratio (aOR)=0.88; 95% CI: 0.31-1.97], but was associated with hospitalization (aOR=3.18; 95% CI: 1.52-6.00). A total of 135 (1%) of all croup episodes had at least 1 adverse event within 30 days. Of those treated with 0.15 or 0.6 mg/kg, 1.2% and 1%, respectively, had at least 1 adverse event within 30 days. The most common adverse event was pneumonia (0.8%). Conclusions: Our findings suggest that low-dose dexamethasone, 0.15 mg/kg, may be as effective as 0.6 mg/kg with comparable proportions of ED return visits and adverse events within 7 days. However, low-dose dexamethasone was associated with increased hospitalization. Clinicians should weigh the potential risk of hospitalization when choosing 0.15 mg/kg of dexamethasone.