• T P Klassen, W R Craig, D Moher, M H Osmond, H Pasterkamp, T Sutcliffe, L K Watters, and P C Rowe.
• Department of Pediatrics, University of Ottawa, Ontario, Canada. terry.klassen@sympatico.ca
• JAMA. 1998 May 27; 279 (20): 1629-32.

ContextThe effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective.ObjectiveTo determine the effectiveness of 3 glucocorticoid regimens in patients with croup.DesignRandomized controlled trial with parallel design.SettingEmergency departments of 2 Canadian pediatric tertiary care hospitals.ParticipantsChildren with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy.InterventionsOral dexamethasone, 0.6 mg/kg, and nebulized placebo; oral placebo and nebulized budesonide, 2 mg; or oral dexamethasone, 0.6 mg/kg, and nebulized budesonide, 2 mg.Main Outcome MeasuresWestley croup score (primary outcome), hospital admission rates, time spent in the emergency department, return visits to the emergency department, or ongoing symptoms at 1 week.ResultsThe mean change in the croup score from baseline to the final study assessment was -2.3 (95% confidence interval [CI], -2.6 to -2.0) in the budesonide group (n = 65), -2.4 (95% CI, -2.6 to -2.2) in the dexamethasone group (n = 69), and -2.4 (95% CI, -2.7 to -2.1) in the budesonide and dexamethasone group (n = 64, P = .70).ConclusionsBased on the similar outcomes in the 3 groups, oral dexamethasone is the preferred intervention because of its ease of administration, lower cost, and more widespread availability.

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