12. Dexamethasone 0.60 mg per kg compared to dexamethasone 0.15 mg per kg for croup.

Dexamethasone 0.60 mg per kg compared to dexamethasone 0.15 mg per kg for croup
Patient or population: children with croup Intervention: dexamethasone 0.60 mg per kg Comparison: dexamethasone 0.15 mg per kg
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)
	Dexamethasone 0.15 mg per kg	Dexamethasone 0.60 mg per kg
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 ‐1.05.	The mean change in croup score was 0.15 units more (0.29 more to 0.01 more).	‐	41 (1 RCT)	⊕⊕⊝⊝ LOWa, b
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 was ‐3.10 to ‐2.09.	The mean change in croup score was 0.33 units more (0.50 more to 0.16 more).	‐	178 (3 RCTs)	⊕⊕⊕⊝ MODERATEc
Change in croup score. Assessed with the Westley croup score. Lower scores mean fewer symptoms. (follow‐up: 12 hours)	The mean change in croup score was ‐3.50 to ‐2.95.	The mean change in croup score was 0.17 units less (1.45 more to 1.78 less).	‐	113 (2 RCTs)	⊕⊝⊝⊝ VERY LOWd, e
Change in croup score. Assessed with the Westley croup score. Lower scores mean fewer symptoms. (follow‐up: 24 hours)	The mean change in croup score from 1 study was ‐4.00.	The mean change in croup score was 0.50 units less (0.14 less to 0.86 less).	‐	72 (1 RCT)	⊕⊕⊝⊝ LOWf, g
Return visits or (re)admissions or both	Study population		RR 0.92 (0.54 to 1.55)	129 (2 RCTs)	⊕⊕⊝⊝ LOWh
	288 per 1000	265 per 1000 (155 to 446)
Adverse events	Alshehr 2005 reported 1 case of bacterial tracheitis and 2 cases of bronchopneumonia in the 0.60 mg/kg dexamethasone group (3/36, 8.3%) and no adverse events in the 0.15 mg/kg dexamethasone group. Chub‐Uppakarn 2007 and Fifoot 2007 reported no adverse events from 0.15 mg/kg or 0.60 mg/kg dexamethasone.
*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 inconsistency. As there was only one study in the analysis, there was no evidence of consistency.
 ^bWe downgraded by one level for imprecision. The sample size was small (did not meet the optimal information size).
 ^cWe downgraded by one level for imprecision. The sample size was small (did not meet the optimal information size).
 ^dWe downgraded by two levels level for inconsistency. There was considerable heterogeneity (I² = 99%), and variation in point estimates. The 95% confidence intervals did not overlap.
 ^eWe 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 and harm for 0.60 mg/kg compared to 0.15 mg/kg dexamethasone.
 ^fWe downgraded by one level for inconsistency. As there was only one study in the analysis, there was no evidence of consistency.
 ^gWe downgraded by one level for imprecision. The sample size was small (did not meet the optimal information size).
 ^hWe downgraded by two levels for imprecision. The sample size was small (did not meet the optimal information size). The effect estimate included the null effect as well as appreciable benefit and harm for 0.60 mg/kg compared to 0.15 mg/kg dexamethasone.