Table 1.
GRADE evaluation of interventions for dengue fever or dengue shock sydrome in children
| Important outcomes | Symptom severity, mortality, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of supportive treatments for dengue haemorrhagic fever or dengue shock syndrome in children? | |||||||||
| 3 (655) | Symptom severity | Crystalloids v colloids | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for delayed measurement of outcome |
| 1(383) | Symptom severity | Ringer's lactate v colloids (moderately severe shock) | 4 | 0 | 0 | 0 | 0 | High | |
| 1(129) | Symptom severity | Dextran v starch solutions (severe shock) | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 2 (172) | Symptom severity | Carbazochrome v placebo | 4 | –3 | –1 | –1 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results, no intention-to-treat analysis, and methodological flaws. Consistency point deducted for conflicting results. Directness point deducted for baseline differences of population (uncertainty about duration of illness or age of participants) |
| at least 2 RCTs (at least 89 children) | Symptom severity | Corticosteroids v no treatment | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and methodological weaknesses (open label trial with unclear randomisation and allocation concealment). Directness points deducted for baseline differences between groups and disparity in numbers of participants in comparator groups |
| 4 (284) | Mortality | Corticosteroids v placebo or no treatment | 4 | –3 | –1 | –2 | 0 | Very low | Quality points deducted for methodological weaknesses (open label trial with unclear randomisation and allocation concealment, and disparities in reporting of results in text article and table of results). Consistency point deducted for conflicting results. Directness points deducted for baseline differences between groups and disparity in numbers of participants in comparator groups |
| 1 (31) | Symptom severity | Intravenous immunoglobulin (IVIG) v no IVIG | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (216) | Mortality | Intravenous immunoglobulin v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 1 (25) | Symptom severity | Recombinant activated factor VII (rFVIIa) | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
Type of evidence: 4 = RCT; 2 = ObservationalConsistency: similarity of results across studies Directness: generalisability of population or outcomes Effect size: based on relative risk or odds ratio