4. Dexamethasone compared to betamethasone for croup.

Dexamethasone compared to betamethasone for croup
Patient or population: children with croup Intervention: dexamethasone Comparison: betamethasone
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)
	Betamethasone	Dexamethasone
Change in croup score. Assessed with the Westley croup score. Lower scores mean fewer symptoms. (follow‐up: 2 hours)	The mean change in croup score from 1 study was ‐1.68.	The mean change in croup score was 1.38 units more (2.58 more to 0.18 more).	‐	52 (1 RCT)	⊕⊝⊝⊝ VERY LOWa, b, c
Change in croup score. Assessed with the Westley croup score. Lower scores mean fewer symptoms. (follow‐up: 6 hours)	The mean change in croup score from 1 study was ‐1.89.	The mean change in croup score was 1.53 units more (2.75 more to 0.31 more).	‐	52 (1 RCT)	⊕⊝⊝⊝ VERY LOWd, e, f
Return visits or (re)admissions or both	Study population		RR 0.95 (0.67 to 1.34)	52 (1 RCT)	⊕⊝⊝⊝ VERY LOWg, h
	731 per 1000	694 per 1000 (490 to 979)
Adverse events	Amir 2006 did not report collecting adverse events data.
*The risk in the intervention group (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). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

^aWe downgraded by one level for risk of bias. The one contributing study was at high risk of bias. Allocation concealment was unclear, and the study was not blinded. There was a baseline imbalance in croup score.
 ^bWe downgraded by one level for inconsistency. As there was only one study in the analysis, there was no evidence of consistency.
 ^cWe downgraded by one level for imprecision. The sample size was small (did not meet the optimal information size).
 ^dWe downgraded by one level for risk of bias. The one contributing study was at high risk of bias. Allocation concealment was unclear, and the study was not blinded. There was a baseline imbalance in croup score.
 ^eWe downgraded by one level for inconsistency. As there was only one study in the analysis, there was no evidence of consistency.
 ^fWe downgraded by one level for imprecision. The sample size was small (did not meet the optimal information size).
 ^gWe downgraded by one level for inconsistency. As there was only one study in the analysis, there was no evidence of consistency.
 ^hWe downgraded by two levels for imprecision. The sample size was small (did not meet the optimal information size). The effect estimate included both the null effect and appreciable benefit or harm for dexamethasone compared to betamethasone.