Ledwith's group monitored patients for 3 h after epinephrine nebulization and found that 38 percent of the patients who had a recurrence requiring admission did so between the second and third hour.8 Prendergast et al. also demonstrated that there was an upward trend in the croup score between the second and third hours only in those patients ultimately requiring admission.9 The current standard of care for moderate to severe croup is to administer nebulized epinephrine with early steroids (see below) and monitor these patients in the ED for at least 3 h before considering discharge ( Table 129-5).
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