To evaluate and update clinical evidence regarding nebulized epinephrine use for croup among children.
Approach:
Study Registration: The protocol was registered in PROSPERO under CRD420251160013.
Search Strategy: A comprehensive search was conducted across multiple databases for randomized controlled trials evaluating epinephrine for croup treatment.
Inclusion Criteria: Included studies involved children with acute croup receiving nebulized epinephrine compared to control.
Data Extraction: Data was independently extracted and verified by multiple reviewers.
Quality Assessment: Risk of bias was assessed using the Cochrane Risk of Bias Tool.
Key Findings:
Nebulized epinephrine significantly reduced croup severity scores 30 minutes after administration (SMD = -1.48, 95% CI [-2.83, -0.13]).
The benefit of nebulized epinephrine was not maintained at 2 hours (SMD = -0.51, 95% CI [-1.11, 0.09]).
Hospital stay showed a potentially meaningful reduction (MD = -25.1 h, 95% CI [-52.34, 2.15]), but did not achieve statistical significance (P = 0.07).
Interpretation:
Current evidence does not support routine administration of nebulized epinephrine to shorten hospitalization.
Limitations:
Sensitivity analysis for persistent benefit at 2 hours was unstable.
The confidence interval for hospital stay reduction was wide and crossed zero, indicating uncertainty in the estimate.
Conclusion:
Nebulized epinephrine provides significant short-term improvement in croup severity but lacks sustained benefit over time.
