7. Budesonide and dexamethasone compared to dexamethasone.
| Budesonide and dexamethasone compared to dexamethasone for croup | ||||||
| Patient or population: children with croup Setting: emergency department, inpatients and outpatients Intervention: budesonide and dexamethasone Comparison: dexamethasone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments** | |
| Dexamethasone | Budesonide and dexamethasone | |||||
| Change in croup score. Assessed with different scores in different studies. Lower scores mean fewer symptoms. (Follow‐up: 6 hours) |
The mean change in croup score was −3.24 to −1.80. | The mean change in croup score was 0.05 standard deviations not in favour (0.19 more to 0.30 less). | ‐ | 255 (3 RCTs) | ⊕⊕⊕⊝ Moderatea | A standard deviation of 0.05 represents a minimal difference between groups. |
| Return visits or (re)admissions or both | Study population | RR 0.91 (0.45 to 1.83) | 254 (3 RCTs) | ⊕⊕⊝⊝ Lowb | ||
| 100 per 1000 | 91 per 1000 (45 to 183) | |||||
| Adverse events | 1/3 (33%) studies reported collecting adverse events data. Klassen 1998 reported no adverse events in either the dexamethasone group or the dexamethasone and budesonide group. | 133 (1 RCTs) |
⊕⊕⊕⊝ Moderatec | |||
| *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).
**We used Cohen's interpretation of effect sizes to determine the magnitude of the difference between groups (0.2 represents a small effect, 0.5 represents a medium effect, 0.8 represents a large effect). 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 imprecision. The sample size was small (did not meet the optimal information size). bWe 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 a significant benefit or harm for dexamethasone and budesonide compared to dexamethasone alone. cWe downgraded by one level for imprecision. Narrative sythesis was conducted, estimates are not precise.