Management and referral of acute laryngotracheitis - Croup: The New South Wales Neonatal and Paediatric Emergency Transport Service experience

Aim To evaluate the experience of NETS (The Newborn and paediatric Emergency Transport Service) New South Wales (NSW) with children referred with a provisional diagnosis of croup. To examine the adherence of referral hospitals to NSW Health policy guidelines and to establish criteria for the need to transfer and the level of escort required for a child with croup to a higher level of care. Methods A retrospective audit of all children with a provisional diagnosis of croup referred to NETS over the epoch: 2005-2015. The NETS database was searched for keywords: croup and laryngotracheitis. Demographics, retrieval characteristics and management strategies were collected. Results A total of 432 patients were identified. The number of children triaged to a medically led NETS team for transfer decreased (P < 0.001) whilst those transferred into more local regional or metropolitan hospitals (P < 0.001) increased. The number of adrenaline doses was not associated with intensive care admissions or the need for invasive ventilation. Conclusion Medically led retrieval teams are not necessary for safe transfer of children with a provisional diagnosis of croup unless the airway is secured with an endotracheal tube. Transfer to more local hospitals for paediatric care should be considered and time allowed for medications to take effect prior to movement.