Table A
Characteristics of randomised controlled trials of treatments for croup included in the meta-analysisTrial | No of patients | Setting | Intervention | Control | Outcomes | Jadad score * | Allocation Concealment †|
Cruz 1995w1 | 45 | Accident and emergency | Intramuscular dexamethasone 0.6 mg/kg | Placebo | Clinical improvement, visits to the doctor, readmissions | 2 | 1 |
Eden 1964w2 | 50 | Hospital | Intramuscular methylprednisolone 4 mg/kg/day | Placebo | Clinical improvement, use of mist tent and antibiotics | 3 | 3 |
Eden 1967w3 | 50 | Hospital | Intramuscular dexamethasone 0.4 mg/kg/day | Placebo | Stridor, dyspnoea, retractions, and cyanosis | 3 | 3 |
Fitzgerald 1996w4 | 67 | Hospital | Nebulised budesonide 2 mg | L-epinephrine 4 mg | Modified Westley croup score, use of epinephrine and steroids, length of hospital stay | 3 | 2 |
Geelhoed 1995w5 | 80 | Accident and emergency | Nebulised budesonide 2 mg Oral dexamethasone 0.6 mg/kg | Placebo | Stridor and retractions, use of epinephrine, length of stay in observation unit | 3 | 3 |
Geelhoed 1995aw6 | 60 | Accident and emergency | Oral dexamethasone 0.6 mg/kg | Oral dexamethasone 0.3 mg/kg | Stridor and retractions, use of epinephrine, length of stay in observation unit | 3 | 3 |
Geelhoed 1995bw6 | 60 | Accident and emergency | Oral dexamethasone 0.3 mg/kg | Oral dexamethasone 0.15 mg/kg | Proportion hospitalised in 24 hours |
|
|
Geelhoed 1996w7 | 100 | Accident and emergency | Oral dexamethasone 0.15 mg/kg | Placebo | Return to accident and emergency department for symptoms of croup | 2 | 3 |
Godden 1997w8 | 87 | Hospital | Nebulised budesonide 2 mg initially, then 1 mg every 12 hours during hospitalization | Placebo | Modified Westley croup score, use of epinephrine and intubation, length of stay | 4 | 3 |
Husby 1993w9 | 37 | Hospital | Nebulised budesonide 1mg/dose for two doses 30 minutes apart | Placebo | Modified Westley croup score, use of antibiotics | 3 | 3 |
James 1969w10 | 88 | Hospital | Intramuscular dexamethasone 4 -12 mg | Placebo | Use of mist tent or antibiotics, tracheostomy | 4 | 3 |
Johnson 1996w11 | 55 | Accident and emergency | Nebulised dexamethasone 10-20 mg | Placebo | Modified Westley croup score, admission rate | 4 | 1 |
Johnson 1998w12 | 144 | Accident and emergency | Nebulised budesonide 4 mg | Placebo | Westley croup score, use of epinephrine and mist treatment | 2 | 1 |
Klassen 1998w13 | 198 | Accident and emergency | Nebulised budesonide 2 mg Nebulised budesonide 2 mg and oral dexamethasone 0.6 mg/kg | Oral dexamethasone 0.6 mg/kg | Westley croup score, use of epinephrine and steroids, length of stay, admission rates | 5 | 1 |
Klassen 1994w14 | 54 | Accident and emergency | Nebulised budesonide 2 mg | Placebo | Westley croup score, use of epinephrine and steroids, length of stay, admission rates | 5 | 1 |
Klassen 1996w15 | 50 | Accident and emergency | Nebulised budesonide 2 mg and oral dexamethasone 0.6 mg/kg | Oral dexamethasone 0.6 mg/kg | Westley croup score, use of epinephrine and steroids, length of stay, admission rates | 5 | 1 |
Koren 1983w16 | 78 | Hospital | Intramuscular dexamethasone 0.6 mg/kg | Placebo | Respiratory rate | 2 | 3 |
Kuusela 1988w17 | 72 | Hospital | Intramuscular dexamethasone 0.6 mg/kg, Intramuscular dexamethasone 0.6 mg/kg, and L-epinephrine 2.25% 0.25 ml/kg | L-epinephrine 2.25% 0.25 ml/kg | Dyspnoea and cough, length of stay | 3 | 1 |
Leipzig 1979w18 | 30 | Hospital | Intramuscular dexamethasone 0.3 mg/kg/dose for two doses | Placebo | Stridor, cyanosis, retractions, respiratory rate, heart rate Use of epinephrine and intubation Length of stay | 3 | 3 |
Martinez 1993w19 | 66 | Hospital | L-epinephrine, L-epinephrine and intramuscular dexamethasone 0.5 mg/kg, intramuscular dexamethasone 0.5 mg/kg | Placebo | Stridor, dyspnoea, cough, cyanosis, use of mist treatment | 3 | 1 |
Massicotte 1973w20 | 42 | Hospital | Intravenous methylprednisolone 4 mg at 0, 4, and 8 hours | Placebo | Clinical improvement, use of antibiotics and tracheostomy | 4 | 1 |
Muhlendahl 1982w21 | 406 | Hospital | Oral dexamethasone 6 mg | Placebo | Westley croup score, clinical improvement, tracheostomy, length of stay | 2 | 3 |
Skowron 1966w22 | 200 | Hospital | Subcutaneous dexamethasone 4 or 6 mg | Placebo | Use of mist treatment, antibiotics, tracheostomy | 2 | 3 |
Super 1989w23 | 29 | Hospital | Intramuscular dexamethasone 0.6 mg/kg | Placebo | Westley croup score, clinical improvement, use of epinephrine, steroids, mist treatment, length of stay | 5 | 1 |
Tibballs 1992w24 | 73 | Intensive care unit (intubated patients) | Nasogastric prednisolone 2 mg/kg/day until 24 hours after extubation | Placebo | Length of intubation reintubation rate | 4 | 1 |
*Five point scale.
†Scored as 1=adequate, 2=inadequate, 3=unclear.
References:
w1 Cruz MN, Stewart G, Rosenberg N. Use of dexamethasone in the outpatient management of acute laryngotracheitis. Pediatrics 1995;96:220-3.
w2 Eden AN, Larkin VP. Corticosteroid treatment of croup. Pediatrics 1964;33:768-9.
w3 Eden AN, Kaufman A, Yu R. Corticosteroids and croup: controlled double-blind study. JAMA 1967;200:403-4.
w4 Fitzgerald D, Mellis C, Johnson M, Allen H, Cooper P, Van Asperen P. Nebulized budesonide is as effective as nebulized adrenaline in moderately severe croup. Pediatrics 1996;97:722-5.
w5 Geelhoed GC, Macdonald WB. Oral and inhaled steroids in croup: a randomized, placebo-controlled trial. Pediatr Pulmonol 1995;20:355-61.
w6 Geelhoed GC, Macdonald WB. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995;20:362-8.
w7 Geelhoed GC, Turner J, Macdonald WB. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ 1996;313:140-2.
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w9 Husby S, Agertoft L, Mortensen S, Pedersen S. Treatment of croup with nebulised steroid (budesonide): a double blind, placebo controlled study. Arch Dis Child 1993;68:352-5.
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w14 Klassen TP, Feldman ME, Watters LK, Sutcliffe T, Rowe PC. Nebulized budesonide for children with mild-to-moderate croup. N Engl J Med 1994;331:285-9.
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w19 Martinez Fernandez A, Sanchez Gonzalez E, Rica Etxebarria I, Echaniz Urcelay I, Alonso Diez M, Vilella Ciriza M, et al. [Randomized double-blind study of treatment of croup with adrenaline and/or dexamethasone in children]. Anales Españoles de Pediatría 1993;38:29-32. (In Spanish.)
w20 Massicote P, Tetreault L. [Evaluation of methyl-prednisolone in the treatment of acute laryngitis in children]. Union Med Can 1973;102:2064-72. (In French.)
w21 Von Muhlendahl KE, Kahn D, Spohr HL, Dressler F. Steroid treatment in pseudo-croup. Helv Paediatr Acta 1982;37:431-6.
w22 Skowron PN, Turner JA, McNaughton GA. The use of corticosteroid (dexamethasone) in the treatment of acute laryngotracheitis. Can Med Assoc J 1966;94:528-31.
w23 Super DM, Cartelli NA, Brooks LJ, Lembo RM, Kumar ML. A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis. J Pediatr 1989;115:323-9.
w24 Tibballs J, Shann FA, Landau LI. Placebo-controlled trial of prednisolone in children intubated for croup. Lancet 1992;340:745-8.