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Meta-Analysis
. 2018 Aug 22;8(8):CD001955.
doi: 10.1002/14651858.CD001955.pub4.

Glucocorticoids for croup in children

Allison Gates  1 , Michelle Gates, Ben Vandermeer, Cydney Johnson, Lisa Hartling, David W Johnson, Terry P Klassen
Affiliations
Meta-Analysis

Glucocorticoids for croup in children

Allison Gates et al. Cochrane Database Syst Rev. .

Update in

  • Glucocorticoids for croup in children.
    Aregbesola A, Tam CM, Kothari A, Le ML, Ragheb M, Klassen TP. Aregbesola A, et al. Cochrane Database Syst Rev. 2023 Jan 10;1(1):CD001955. doi: 10.1002/14651858.CD001955.pub5. Cochrane Database Syst Rev. 2023. PMID: 36626194 Free PMC article. Review.

Abstract

Background: Glucocorticoids are commonly used for croup in children. This is an update of a Cochrane Review published in 1999 and previously updated in 2004 and 2011.

Objectives: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 2, 2018), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid MEDLINE (1946 to 3 April 2018), and Embase (Ovid) (1996 to 3 April 2018, week 14), and the trials registers ClinicalTrials.gov (3 April 2018) and the World Health Organization International Clinical Trials Registry Platform (ICTRP, 3 April 2018). We scanned the reference lists of relevant systematic reviews and of the included studies.

Selection criteria: We included randomised controlled trials (RCTs) that investigated children aged 0 to 18 years with croup and measured the effects of glucocorticoids, alone or in combination, compared to placebo or another pharmacologic treatment. The studies needed to report at least one of our primary or secondary outcomes: change in croup score; return visits, (re)admissions or both; length of stay; patient improvement; use of additional treatments; and adverse events.

Data collection and analysis: One author extracted data from each study and another verified the extraction. We entered the data into Review Manager 5 for meta-analysis. Two review authors independently assessed risk of bias for each study using the Cochrane 'Risk of bias' tool and the certainty of the body of evidence for the primary outcomes using the GRADE approach.

Main results: We added five new RCTs with 330 children. This review now includes 43 RCTs with a total of 4565 children. We assessed most (98%) studies as at high or unclear risk of bias. Compared to placebo, glucocorticoids improved symptoms of croup at two hours (standardised mean difference (SMD) -0.65, 95% confidence interval (CI) -1.13 to -0.18; 7 RCTs; 426 children; moderate-certainty evidence), and the effect lasted for at least 24 hours (SMD -0.86, 95% CI -1.40 to -0.31; 8 RCTs; 351 children; low-certainty evidence). Compared to placebo, glucocorticoids reduced the rate of return visits or (re)admissions or both (risk ratio 0.52, 95% CI 0.36 to 0.75; 10 RCTs; 1679 children; moderate-certainty evidence). Glucocorticoid treatment reduced the length of stay in hospital by about 15 hours (mean difference -14.90, 95% CI -23.58 to -6.22; 8 RCTs; 476 children). Serious adverse events were infrequent. Publication bias was not evident. Uncertainty remains with regard to the optimal type, dose, and mode of administration of glucocorticoids for reducing croup symptoms in children.

Authors' conclusions: Glucocorticoids reduced symptoms of croup at two hours, shortened hospital stays, and reduced the rate of return visits to care. Our conclusions have changed, as the previous version of this review reported that glucocorticoids reduced symptoms of croup within six hours.

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Conflict of interest statement

Allison Gates: None known. Michelle Gates: None known. Ben Vandermeer: None known. Cydney Johnson: None known. Lisa Hartling: None known. David W Johnson: is an author of three of the included studies (Bjornson 2004; Johnson 1996; Johnson 1998). Terry P Klassen: is an author of four of the included studies (Bjornson 2004; Klassen 1994; Klassen 1996; Klassen 1998).

Figures

1
1
Flow diagram of study selection for the 2018 update searches. In 2014, the review authors identified 30 studies in an interim update search. The review authors included one new study, Dobrovoljac 2012, and excluded one new study, Faghihinia 2007.
2
2
Risk of bias graph: Review authors' judgements of risk of bias for each domain and overall presented as percentages across all included studies.
3
3
Risk of bias summary: Review authors' judgements of risk of bias among seven domains and overall for each included study.
4
4
Cumulative meta‐graph by year for change in croup score six hours after treatment for any glucocorticoid compared to placebo.
5
5
Cumulative meta‐graph by year for return visits or (re)admissions or both for any glucocorticoid compared to placebo.
See this image and copyright information in PMC

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