Table.
GRADE Evaluation of interventions for Dengue haemorrhagic fever or dengue shock syndrome in children.
| Important outcomes | Mortality, Symptom severity | ||||||||
| 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 versus colloids | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for small RCTs (may have been underpowered to detect a clinically significant difference in outcomes) |
| 3 (655) | Mortality | Crystalloids versus colloids | 4 | 0 | 0 | –2 | 0 | Low | Directness points deducted for RCT being underpowered to detect difference in outcome (1 event only) and no statistical analysis between groups |
| 2 (89) | Symptom severity | Adding corticosteroids to standard intravenous fluids versus adding placebo or no corticosteroids | 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 | Adding corticosteroids to standard intravenous fluids versus adding placebo or no corticosteroids | 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 | Adding intravenous immunoglubulin (IVIG) to standard intravenous fluids versus no IVIG | 4 | –1 | 0 | –2 | 0 | Very low | Quality point deducted for sparse data; directness points deducted for population not having fever or shock and limited outcomes (non-clinical) |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.