Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Children 0-24 months with a first episode of viral bronchiolitis presenting as inpatients (studies in children in the intensive-care setting and/or children who were intubated or ventilated were excluded)
Intervention: Nebulised adrenaline ᵃ
Comparison: Placebo ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Length of hospital stay | No statistically significant difference | Moderate |
Clinical score measured using a variety of scales at 60 minutes | No statistically significant difference | Moderate |
Hospital readmissions | No statistically significant difference | GRADE assessment not performed for this outcome |
Return visits (Emergency Department [ED] or any healthcare provider) | No statistically significant difference | GRADE assessment not performed for this outcome |
Adverse effects | Unknown ᵇ | GRADE assessment not performed for this outcome |
Note The CCA notes that the efficacy of adrenaline versus placebo or other active comparators in hospitalised children may be difficult to interpret due to: underpowered studies failing to detect differences between treatment groups; wide confidence intervals leading to imprecise results; and a lack of other active interventions being compared with placebo. The reviewers noted that there is not enough evidence to support the use of adrenaline, with or without corticosteroids, for the treatment of bronchiolitis among inpatients. ᵃ This evidence table summarises the findings for the comparison nebulised adrenaline versus placebo, which is the main comparison as stated in the Cochrane review Summary of Findings table. See the full Cochrane Clinical Answer (CCA) for information on other comparisons (adrenaline versus salbutamol; adrenaline versus salbutamol plus ipratropium). ᵇ Results reported narratively (one RCT, participant numbers not reported; incidence of adverse events were reported in inpatients at the beginning of the study but the statistical significance of differences between treatment groups was not reported; no occurrences of vomiting, pallor, tremor, or arrhythmias were found).
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- In infants and young children with acute viral bronchiolitis, what are the effects of glucocorticoids?
- What are the benefits and harms of antibiotics in children with bronchiolitis?
- For infants with acute bronchiolitis, what are the benefits and harms of nebulized hypertonic saline solution?
- How does epinephrine affect outcomes in outpatients with bronchiolitis?
- How does epinephrine affect outcomes in inpatients with bronchiolitis?
- In infants with bronchiolitis, is there randomized controlled trial evidence to support the use of heliox inhalation therapy?
- How does montelukast affect outcomes in children up to 24 months of age hospitalized with bronchiolitis?
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