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2014 ; 2014
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English Wikipedia
Croup
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Johnson DW
BMJ Clin Evid
2014[Sep]; 2014
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INTRODUCTION: Croup is characterised by the abrupt onset, most commonly at night,
of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due
to upper airway obstruction. It leads to signs of upper airway obstruction, and
must be differentiated from acute epiglottitis, bacterial tracheitis, or an
inhaled foreign body. Croup affects about 3% of children per year, usually
between the ages of 6 months and 3 years, and 75% of infections are caused by
parainfluenza virus. Symptoms usually resolve within 48 hours, but severe upper
airway obstruction can, rarely, lead to respiratory failure and arrest. METHODS
AND OUTCOMES: We conducted a systematic review and aimed to answer the following
clinical questions: What are the effects of treatments in children with mild
croup and moderate to severe croup? We searched: Medline, Embase, The Cochrane
Library, and other important databases up to November 2013 (Clinical Evidence
reviews are updated periodically; please check our website for the most
up-to-date version of this review). We included harms alerts from relevant
organisations such as the US Food and Drug Administration (FDA) and the UK
Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 19
studies that met our inclusion criteria. We performed a GRADE evaluation of the
quality of evidence for interventions. CONCLUSIONS: In this systematic review we
present information relating to the effectiveness and safety of the following
interventions: corticosteroids (dexamethasone, intramuscular and oral), nebulised
budesonide, oral prednisolone, heliox, humidification, and nebulised adrenaline
(racemate and L-adrenaline [ephinephrine]).