Context. - The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective. Objective. - To determine the effectiveness of 3 glucocorticoid regimens in patients with croup. Design. - Randomized controlled trial with parallel design. Setting. - Emergency departments of 2 Canadian pediatric tertiary care hospitals. Participants. - Children 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. Interventions. - Oral 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 Measures. - Westley 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. Results. - The mean change in the croup score from baseline to the final study assessment was -2.3 (95% confidence interval [Cl], -2.6 to-2.0) in the budesonide group (n = 65), -2.4 (95% Cl, -2.6 to -2.2) in the dexamethasone group (n = 69), and -2.4 (95% Cl, -2.7 to -2.1) in the budesonide and dexamethasone group (n = 64, P = .70). Conclusions. - Based 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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