The cost-effective use of nebulized racemic epinephrine in the treatment of croup

The American Journal of Emergency Medicine
L P Thomas, L R Friedland

Abstract

Recent studies have shown that discharging to home an emergency department (ED) patient with croup if the patient is clinically stable 3 to 4 hours after being treated with nebulized racemic epinephrine (NRE) is safe and cost-effective. The objective of this study was to determine if EDs in our geographic area are using NRE cost-effectively in the management of croup. A survey was mailed to the ED medical directors of 23 hospitals in Ohio, Kentucky, and Indiana within a 150-mile radius of our teaching/referral children's hospital. All the hospitals surveyed were community hospitals with EDs and in-patient pediatric units. The survey presented a 2-year-old with a croup-like illness and stridor at rest whom they have just treated with NRE and dexamethasone. The medical directors were asked what their disposition would be once the NRE therapy has been completed: automatically admit, transfer, discharge immediately, or observe for 3 to 4 hours and if stable at that time discharge to home with follow-up. Seven (30%) indicated they would automatically admit, compared with 16 (70%) who indicated they would observe for 3 to 4 hours (P = .06). This article discusses potential reasons that 30% of the ED medical directors in our geographi...Continue Reading

References

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Citations

Oct 12, 2013·The Cochrane Database of Systematic Reviews·Candice BjornsonDavid W Johnson
Mar 24, 2009·The Mount Sinai Journal of Medicine, New York·James StulmanDeborah Korenstein
Jul 31, 2009·Journal of Continuing Education in Nursing·Angela JukkalaShannon Graham
Jan 15, 2010·Plastic and Reconstructive Surgery·Oluseyi Aliu, Kevin C Chung
Aug 9, 2007·Journal of Evaluation in Clinical Practice·Akbar Soltani, Alireza Moayyeri

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