WMJ Vol 121 Issue 1: Retrospective Evaluation of Return Rates in Pediatric Patients Treated With Inhaled Racemic Epinephrine for Croup

ABSTRACT

Background: Croup (viral laryngotracheitis) is a respiratory illness that often affects infants and young children.

Objectives: To determine if the length of observation (< 2 hours vs ≥ 2 hours) following treatment of croup with inhaled racemic epinephrine in the emergency department (ED) is associated with return rates (within 48 hours after treatment) in pediatric patients.

Methods: We conducted a retrospective review of patients’ medical records from February 2010 through June 2018 for pediatric patients (male and female, ≤ 12 years of age) diagnosed with croup in the ED, treated with racemic epinephrine, and discharged from the ED.

Results: We evaluated patients observed for less than 1 hour, 1 to 2 hours, and greater than 2 hours to determine difference in return rates within 48 hours. For patients with mild croup symptoms, 2% observed for less than 1 hour returned; 5% observed for 1 to 2 hours returned, and 3% observed for greater than 2 hours returned. Of the patients with moderate croup symptoms, 29% observed for less than 1 hour returned, 20% observed for 1 to 2 hours returned, and 20% observed for greater than 2 hours returned. A majority who returned for follow-up were not retreated with racemic epinephrine.

Conclusion: Based on our study results, we can conclude that observing patients following treatment of croup with inhaled racemic epinephrine in the ED for less than 2 hours did not increase their risk of deterioration or need to return. Our data did not show that a longer observation time resulted in lower return rates within 48 hours.

Intended Audience

The target audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.

Learning Objectives

As a result of this journal-based activity, learners will be able to:

  1. Reflect on encounters with patients with viral laryngotracheitis (croup) in the learner’s team-based clinical practice.
  2. Summarize the results of a retrospective study that was conducted to determine if the length of observation (< 2 hours vs ≥ 2 hours) following treatment of croup with inhaled racemic epinephrine in the emergency department was associated with return rates (within 48 hours after treatment) in pediatric patients.
  3. Discuss implications of this study for future guide­lines for observation time following inhaled racemic epinephrine treatment for croup.
Course summary
Available credit: 
  • 1.00 AAPA Category 1 CME
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC Contact Hours
  • 1.00 University of Wisconsin–Madison Continuing Education Hours
    • 1.00 Approved for AMA PRA Category 1 Credit™
Registration opens: 
10/01/2022
Course expires: 
09/30/2023
Cost:
$0.00
Part of: 
Wisconsin Medical Journal Volume 121
Rating: 
0

FACULTY DISCLOSURE

It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the  speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE).  In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.

For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.

Name of IndividualIndividual's Role in Activity

Financial Relationship Disclosure

Discussion of
Unlabeled/Unapproved
Uses of Drugs/Devices
in Presentation?

Marianna Shershneva, MD, PhDAccreditation SpecialistNo relevant relationships with ineligible companies to discloseNo
Inimfon Udoh, MDAuthorNo relevant relationships with ineligible companies to discloseNo
David Heegeman, MDAuthorNo relevant relationships with ineligible companies to discloseNo
Shalini Ravi, MDAuthorNo relevant relationships with ineligible companies to discloseNo
Andrea Ildiko Martonffy, MDReviewerNo relevant relationships with ineligible companies to discloseNo
George E MacKinnon III, PhD, MS, RPh, FASHPReviewerNo relevant relationships with ineligible companies to discloseNo
Sarina Schrager, MD, MSEditorNo relevant relationships with ineligible companies to discloseNo
Laura Ozkan, PAEditorNo relevant relationships with ineligible companies to discloseNo
Roberta Pawlak, PhD, RN, NEA-BCReviewerNo relevant relationships with ineligible companies to discloseNo

 

   

*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.

The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.

Discloser List CME Internal Report

Accreditation

Accreditation Statement

Jointly Accredited Provider LogoIn support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal.  The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


Credit Designation Statements

American Medical Association (AMA)

The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC)

The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 ANCC contact hour.  

AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS (AAPA)

The University of Wisconsin–Madison ICEP has been authorized by the American Academy of PAs  (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until 9/30/2023. PAs should only claim credit commensurate with the extent of their participation.

Continuing Education Units

The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.

Available Credit

  • 1.00 AAPA Category 1 CME
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC Contact Hours
  • 1.00 University of Wisconsin–Madison Continuing Education Hours
    • 1.00 Approved for AMA PRA Category 1 Credit™

Cost:
$0.00
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