This prospective cohort study evaluated the effectiveness and safety of a selective discharge policy for patients treated with racemic epinephrine (RE) and intramuscular (IM) dexamethasone (DEX) in the emergency department (ED). Children younger than 13 years of age presenting to the ED with croup who were treated with RE and IM DEX and discharged home were enrolled in the study. Patients were discharged home if they were free of intercostal retractions and stridor at rest, following a 2 h observation period. Telephone follow up determined whether further medical attention for croup was required within 48 h of discharge from the ED. Eighty-two patients were enrolled in the study over a one year period. Six of these patients (7%) required follow up for croup within 48 h of discharge and 2 (2%) required admission. We conclude that a subset of patients with croup treated with RE and IM DEX in the ED can be safely discharged home.