Hanna Jonathan, Brauer Philip R, Morse Elliot, Berson Elisa, Mehra Saral
Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA.
Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA; Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, Yale-New Haven Hospital, Yale Cancer Center, New Haven, CT, USA.
Int J Pediatr Otorhinolaryngol. 2019 Nov;126:109641. doi: 10.1016/j.ijporl.2019.109641. Epub 2019 Aug 13.
To characterize cases of croup presenting to emergency departments (EDs) nationwide, analyze trends, and determine readmission rates.
Retrospective review of the Nationwide Emergency Department Sample (2007-2014) and the National Hospital Ambulatory Medical Care Survey (2008-2015).
Both databases provided similar descriptive statistics. Annual mean of 352,388 (weighted) cases in the National Emergency Department Sample (1.35% of ED cases). Average age and male:female ratio 2.50 years and 1.95:1, respectively. Peak incidence was in autumn (October = 13.7%) with troughs in the summer (July = 3.7%). 21.3% received nebulizers, <1% laryngoscopic or airway procedures, 75.1% steroids, and 13.3% antibiotics. Of the patients receiving antibiotics, 16.0% had isolated croup. 3.0% of cases were admitted to the hospital. No trend was identified in the incidence of croup, mean age, or antibiotic and steroid usage. Hospital admission rates decreased (4.0%-2.3%) and nebulizer usage increased (14.6%-27.5%; p < 0.05). 5% of patients represented repeat admissions (were seen within 72 h prior).
Croup imposes a significant burden on the ED. Although hospital admissions decreased, annual incidence in the ED remained stable. The majority of cases are in males less than three years old, and 5.0% of patients represented readmissions. Only three-quarters received glucocorticoids despite the proven benefits, including reducing readmission rates. Antibiotic usage was high, with a large number representing potential cases of inappropriate antibiotic use.
描述全国急诊科收治的哮吼病例特征，分析趋势，并确定再入院率。
对全国急诊科样本（2007 - 2014年）和国家医院门诊医疗调查（2008 - 2015年）进行回顾性分析。
两个数据库提供了相似的描述性统计数据。全国急诊科样本中年均（加权）病例数为352,388例（占急诊科病例的1.35%）。平均年龄以及男女比例分别为2.50岁和1.95:1。发病高峰在秋季（10月 = 13.7%），低谷在夏季（7月 = 3.7%）。21.3%的患者接受了雾化治疗，<1%接受了喉镜或气道操作，75.1%接受了类固醇治疗，13.3%接受了抗生素治疗。在接受抗生素治疗的患者中，16.0%仅患有哮吼。3.0%的病例住院治疗。哮吼发病率、平均年龄或抗生素及类固醇使用情况未发现趋势。住院率下降（4.0% - 2.3%），雾化治疗使用率上升（14.6% - 27.5%；p < 0.05）。5%的患者为再次入院（在之前72小时内就诊过）。
哮吼给急诊科带来了沉重负担。尽管住院率下降，但急诊科的年发病率保持稳定。大多数病例为3岁以下男性，5.0%的患者为再次入院。尽管已证实包括降低再入院率在内的益处，但只有四分之三的患者接受了糖皮质激素治疗。抗生素使用率很高，其中大量可能存在抗生素使用不当的情况。
