The effectiveness of glucocorticoids in treating croup: meta-analysis

Abstract

<h3>Abstract</h3> <b>Objective:</b> To determine the effectiveness of glucocorticoid treatment in children with croup. <b>Design:</b> Meta-analysis of randomised controlled trials that examine the effectiveness of glucocorticoid treatment in children with croup. <b>Main outcome measures:</b> Score on scale measuring severity of croup, use of cointerventions (adrenaline (epinephrine), antibiotics, or supplemental glucocorticoids), length of stay in accident and emergency or in hospital, and rate of hospitalisation. <b>Results:</b> Twenty four studies met the inclusion criteria. Glucocorticoid treatment was associated with an improvement in the croup severity score at 6 hours with an effect size of −1.0 (95% confidence interval −1.5 to −0.6) and at 12 hours −1.0 (−1.6 to −0.4); at 24 hours this improvement was no longer significant (−1.0, −2.0 to 0.1). There was a decrease in the number of adrenaline treatments needed in children treated with glucocorticoids: a decrease of 9% (95% confidence interval 2% to 16%) among those treated with budesonide and of 12% (4% to 20%) among those treated with dexamethasone. There was also a decrease in the length of time spent in accident and emergency (−11 hours, 95% confidence interval −18 to 4 hours), and for inpatients hospital stay was reduced by 16 hours (−31 to 1 hour). Publication bias seems to play a part in these results. <b>Conclusions:</b> Dexamethasone and budesonide are effective in relieving the symptoms of croup as early as 6 hours after treatment. Fewer cointerventions are used and the length of time spent in hospital is decreased in patients treated with glucocorticoids. <h3>Key messages</h3> Most trials evaluating the treatment of croup are of high methodological quality and hence have a low risk of bias Publication bias, however, seems to be a problem, making the results of this meta-analysis somewhat less certain Glucocorticoids seem to bring about clinical improvement in children with croup within 6 hours Nebulised budesonide or dexamethasone, given either orally or intramuscularly, is effective in treating croup The use of glucocorticoids is associated with a lower rate of use of cointerventions and shortens the time spent in hospital