6429 A service evaluation of croup management in a paediatric emergency department

Objectives Croup is a common emergency presentation for children under 3.¹ Croup can often be successfully treated in the community, but occasionally requires admission or intensive care. Scoring systems including the Westley and modified Taussig Scores can help risk stratify and determine the correct treatment algorithm. Local, national and international guidelines differ in their drugs, dosing and escalation recommendations. This study aims to evaluate the diagnosis, treatment and re-attendance rates of children presenting to the emergency department (ED) of a tertiary hospital with croup. Methods Retrospective service evaluation involving 246 children presenting to paediatric ED over a winter season (01/09/21–28/02/22). Electronic notes from patient's ED attendance were analysed for: date and time of attendance, scoring, vitals, dose, frequency and formulation of drugs, intensive care escalation and re-presentation. Results The mean age of presentation was 37 months and 72% of patients were male. Only 14.2% of patients had scoring used (15 used Westley, 11 used modified Taussig and 10 had unspecified scores). Of clinicians who did use scoring, 63% were ED doctors and 37% paediatricians. There was a significant correlation between severity of croup score, number of steroids used (p=0.000641) and dose given (p=0.0194). 88% of children were given steroids, usually initiated by ED nurses, meaning doctor review occurred after treatment initiation. The average time between 1st and 2nd, and 2nd and 3rd doses was 45 and 143 minutes respectively. Overall 2.8% re-presented with croup later, with an average time between discharge and re-attendance of 40 hours. This had no significant correlation with the dose of steroid used. Conclusion Scoring systems enable risk stratification, selection of appropriate treatment algorithms, and timely escalation, and also have medicolegal implications. The sparse use of scoring, especially in paediatric compared to ED doctors, may reflect differences in awareness, training approaches or documentation style. The majority, but not all, clinicians gave 150mcg/kg dexamethasone regardless of croup severity, in line with literature showing no benefit in higher steroid doses.²Patients also received additional dexamethasone after 45 minutes despite literature showing that maximal effect is only seen at 2 hours.³ Consistent practice will reduce unnecessary steroid administration and additional cost. This evaluation highlights the need for more frequent scoring of croup and closer cohesion between local and national guidelines, which may improve a unified approach among clinicians. References Croup DW. Johnson, 2016. CM Parker, et al. Predinisolone versus dexamethasone for croup: a randomised controlled trial, 2015. A Gates. et al. Glucocorticoids for croup in children, 2022.