8. Budesonide and dexamethasone compared to budesonide.
| Budesonide and dexamethasone compared to budesonide for croup | |||||
| Patient or population: children with croup Setting: emergency department, inpatients and outpatients Intervention: budesonide and dexamethasone Comparison: budesonide | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | |
| Budesonide | Budesonide and dexamethasone | ||||
| Change in croup score. Assessed with the Westley croup score. Lower scores mean fewer symptoms. (Follow‐up: 6 hours) |
The mean change in croup score from 1 study was −2.30. | The mean change in croup score was 0.18 units in favour (0.52 more to 0.17 less). | ‐ | 129 (1 RCT) | ⊕⊕⊕⊝ Moderatea |
| Return visits or (re)admissions or both | Study population | RD 0.00 (−0.03 to 0.03) | 129 (1 RCT) | ⊕⊕⊕⊝ Moderatea | |
| 0 per 1000 | 0 per 1000 (0 to 0) | ||||
| Adverse events | Klassen 1998 reported 1 case of oral thrush in the budesonide group (1/65, 1.5%) and no adverse events in the dexamethasone and budesonide group. | 129 (1 RCT) | ⊕⊕⊕⊝ Moderateb | ||
| *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; RCT: randomised controlled trial; RD: risk difference | |||||
| 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 one level for imprecision. Narrative synthesis was conducted, estimates are not precise.