Summary of findings 1. Corticosteroids compared to placebo for sore throat.
| Corticosteroids compared to placebo for sore throat | ||||||
| Patient or population: patients with sore throat Setting: emergency departments and general practice Intervention: corticosteroids Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with corticosteroids | |||||
| Complete resolution of pain at 24 hours | Study population | RR 2.40 (1.29 to 4.47) | 851 (5 RCTs) | ⊕⊕⊕⊕ HIGH | ||
| 158 per 1000 | 379 per 1000 (204 to 706) | |||||
| Complete resolution of pain at 48 hours | Study population | RR 1.50 (1.27 to 1.76) | 774 (4 RCTs) | ⊕⊕⊕⊕ HIGH | ||
| 327 per 1000 | 491 per 1000 (416 to 576) | |||||
| Mean time to onset of pain relief | The mean time to onset of pain relief was 17.7 (hours). | MD 5.96 lower (8.75 lower to 3.17 lower) | ‐ | 840 (7 RCTs) | ⊕⊕⊕⊝ MODERATE a | Based on a sensitivity analysis the source of heterogeneity is unclear. |
| Mean time to complete resolution of pain | The mean time to complete resolution of pain was 50.4 (hours). | MD 11.62 lower (22.17 lower to 1.08 lower) | ‐ | 695 (6 RCTs) | ⊕⊕⊕⊝ MODERATE b | There was loss to follow‐up as a source of bias for 1 included study. Based on a sensitivity analysis the source of heterogeneity is unclear. |
| Absolute reduction in pain measured by VAS | The mean absolute reduction in pain measured by VAS at 24 hours was 3.7. | MD 1.06 higher (0.21 higher to 1.92 higher) | ‐ | 1004 (7 RCTs) | ⊕⊕⊕⊝ MODERATE c | Different visual analogue scales were used in the included studies. Based on a sensitivity analysis the source of heterogeneity is unclear. |
| Adverse events | Study population | RR 1.08 (0.31 to 3.77) | 690 (2 RCTs) | ⊕⊕⊕⊝ MODERATE d | Only 2 studies included with total number of cases < 345. | |
| 14 per 1000 | 16 per 1000 (4 to 55) | |||||
| Recurrence/relapse rates | Study population | RR 0.52 (0.16 to 1.73) | 353 (3 RCTs) | ⊕⊕⊕⊝ MODERATE e | Only 2 studies included with total number of cases < 200. | |
| 75 per 1000 | 39 per 1000 (12 to 129) | |||||
| Days missed from work or school | The mean number of days missed from work or school was 3.3. | MD 0.28 lower (0.84 lower to 0.28 higher) | ‐ | 405 (2 RCTs) | ⊕⊕⊕⊝ MODERATE f | Only 2 studies included with total number of cases < 250. |
| *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; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio; VAS: visual analogue scale | ||||||
| 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. | ||||||
a‐cDowngraded from high‐ to moderate‐certainty evidence due to substantial heterogeneity. d‐fDowngraded from high‐ to moderate‐certainty evidence due to imprecision.