Summary of findings for the main comparison. Intramuscular corticosteroids compared to Oral corticosteroids for acute asthma.
| Intramuscular corticosteroids compared to Oral corticosteroids for acute asthma | |||||
| Patient or population: patients with acute asthma Settings: Acute care settings Intervention: Intramuscular corticosteroids Comparison: Oral corticosteroids | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Oral corticosteroids | Intramuscular corticosteroids | ||||
| Relapse | 201 per 1000 | 12 fewer per 1000 (from 56 fewer to 48 more) | RR 0.94 (0.72 to 1.24) | 804 (9 studies) | ⊕⊕⊝⊝ low1,2 |
| Relapse within 10 days post‐discharge | 154 per 1000 |
40 fewer per 1000 (from 75 fewer to 11 more) |
RR 0.74 (0.51 to 1.07) | 742 (7 studies) | ⊕⊕⊕⊝ moderate1 |
| Relapse occurring after 10 days post‐discharge | 245 per 1000 | 2 fewer per 1000 (from 64 fewer to 81 more) | RR 0.99 (0.74 to 1.33) | 556 (5 studies) | ⊕⊕⊝⊝ low1,2 |
| Adverse events | 294 per 1000 | 50 fewer per 1000 (from 106 fewer to 21 more) | RR 0.83 (0.64 to 1.07) | 404 (5 studies) | ⊕⊕⊝⊝ low1,3 |
| Pulmonary function: Peak expiratory flow | The mean pulmonary function: peak expiratory flow ranged across control groups from 304 to 419 litres/min | The mean pulmonary function: peak expiratory flow in the intervention groups was 7.78 liters/min lower (38.83 lower to 23.28 higher) | 272 (4 studies) | ⊕⊕⊕⊝ moderate2 | |
| Symptom persistence | 537 per 1000 | 317 fewer per 1000 (from 461 fewer to 107 more) | RR 0.41 (0.14 to 1.2) | 80 (3 studies) | ⊕⊕⊝⊝ low1,3 |
| 24‐hour beta agonist use | 375 per 1000 | 172 fewer per 1000 (from 296 fewer to 139 more) | RR 0.54 (0.21 to 1.37) | 48 (2 studies) | ⊕⊕⊝⊝ low1,3 |
| *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). CI: Confidence interval; RR: Risk ratio; | |||||
| 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. | |||||
1 Downgraded 1 level for risk of bias. Majority of studies received an unclear risk of bias for random sequence generation and selective outcome reporting 2 Downgraded 1 level for imprecision including wide confidence intervals (including both benefit, harm, and no effect) 3 Downgraded 1 level for Imprecision including wide confidence intervals (including both benefit, harm, and no effect) and few events