Summary of findings 2. Hydrocortisone compared to placebo for preventing post‐traumatic stress disorder (PTSD).
| Hydrocortisone compared to placebo for preventing post‐traumatic stress disorder (PTSD) | ||||||
| Patient or population: adult participants (18 years and older) who have been exposed to any traumatic events, but who did not meet the diagnostic criteria for PTSD at study recruitment Settings: in‐ and outpatients Intervention: hydrocortisone Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk1 | Corresponding risk | |||||
| Placebo | Hydrocortisone | |||||
| Treatment efficacy CAPS, SCID‐IV, PTSS‐10Q‐I Follow‐up: median 4.5 months | Study population | RR 0.17 (0.05 to 0.56) | 165 (4 studies) | ⊕⊕⊕⊝ moderate123 | ||
| 100 per 1000 | 17 per 1000 (5 to 56) | |||||
| Moderate | ||||||
| 200 per 1000 | 34 per 1000 (10 to 112) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CAPS: Clinician‐Administered PTSD Scale; CI: confidence interval;PTSS‐10Q‐I: Post‐Traumatic Stress Syndrome 10‐Questions Inventory; RR: risk ratio; SCID‐IV: Structured Clinical Interview for DSM‐IV | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1The assumed risk in the control group is based on an estimated event rate of 10% and 20%, as per Norris 2007.
2Half of the trials reported administering higher levels of norepinephrine to patients on placebo than medication, which may have confounded the evidence of a treatment effect. In a third trial, the differential proportion of drop‐outs between interventions suggests possible attrition bias.
3Few participants and few events and thus wide confidence intervals.