| Study characteristics |
| Methods |
Randomised, double‐blind, 3‐arm, prospective, placebo‐controlled trial in an emergency department setting in the USA. 5‐day follow‐up |
| Participants |
90 participants (45 in each group) aged 4 to 21 years (median 7.7 years) with a positive direct streptococcal antigen test |
| Interventions |
Dexamethasone 0.6 mg/kg/day orally for 1 or 3 days versus oral placebo. 45 received IM and 45 received oral antibiotics (type at discretion of physician). |
| Outcomes |
Time to return of general health. Time to return of normal activity level. Days missed from school or work. Time to complete pain resolution. Number with complete pain resolution at 24 and 48 hours. Percentage recurrence |
| Notes |
Convenience sample. Analgesia use recorded. Funding source/declaration of interest: not declared. No contact with study authors. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Low risk |
Block randomisation in blocks of 9, stratified by IM or oral antibiotics |
| Allocation concealment (selection bias) |
Low risk |
Masked liquid suspension |
| Blinding (performance bias and detection bias)
All outcomes |
Low risk |
Participants and administering personnel blinded to the study drug. Blinding of outcome assessor not explicitly stated. |
| Incomplete outcome data (attrition bias)
All outcomes |
Low risk |
6/90 lost to follow‐up. |
| Selective reporting (reporting bias) |
Low risk |
All outcomes reported. |
| Comparability of groups at baseline |
Low risk |
Comparable apart from gender ‐ shown to have no influence on results |
