Bulloch 2003.

Study characteristics
Methods	Randomised, double‐blind, placebo‐controlled trial in an emergency department setting in Canada. 1‐month follow‐up
Participants	184 children (92 in each group) aged 5 to 16 years (mean 9.74 years) presenting with erythema of the pharynx, onset of symptoms within the previous 48 hours, and 1 chief complaint of sore throat, odynophagia, or dysphagia
Interventions	Dexamethasone 0.6 mg/kg orally (maximum of 10 mg) or placebo orally. All participants with a positive direct antigen test for Streptococcus pyogenes group A antigen from pharyngeal swabs were treated with penicillin V.
Outcomes	Reduction in pain VAS. Time to onset of pain relief, time to complete pain resolution, percentage recurrence
Notes	Analgesia unregulated and unrecorded. Funding source: supported by the Dr Paul HT Thorlakson Foundation Fund. No conflict of interest declared. No contact with study authors.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Block randomisation table with groups of 10 held at a central pharmacy. 2 lists used for those positive and negative on direct antigen testing. Attempted to enrol consecutive children but missed some eligible children when the emergency department was too busy to permit enrolment.
Allocation concealment (selection bias)	Low risk	Placebo with identical appearance and taste used.
Blinding (performance bias and detection bias) All outcomes	Low risk	Double‐blind design. Randomisation code known only pharmacy and not broken until all participants recruited. Outcome assessors blinded to treatment groups.
Incomplete outcome data (attrition bias) All outcomes	Low risk	5/184 failed to complete.
Selective reporting (reporting bias)	Low risk	Main outcome measures in similar trials included. No outcome measures assessed were not reported. Data and confidence intervals clearly reported.
Comparability of groups at baseline	Low risk	Comparable