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 very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Children (mean age 1-3 years where reported) presenting to the emergency department or hospitalized with croup
Intervention: Corticosteroid
Comparison: Placebo or epinephrine ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Corticosteroid versus placebo | ||
Croup score: change from baseline at 2, 6, and 12 hours | Favors intervention | Low |
Croup score: change from baseline at 24 hours | Favors intervention | Very Low |
Return visits, (re)admissions, or both | Favors intervention | Low |
Length of stay in the hospital or emergency department | Favors intervention | GRADE assessment not performed for this outcome |
Improvement at 6, 12, and 24 hours | Favors intervention | GRADE assessment not performed for this outcome |
Additional treatments: antibiotics; epinephrine; intubation/tracheostomy; supplemental corticosteroids | No statistically significant difference | GRADE assessment not performed for this outcome |
Adverse events | See note ᵇ | Low |
Corticosteroid versus epinephrine | ||
Croup score: change from baseline at 2 and 6 hours | No statistically significant difference | Very Low |
Croup score: change from baseline at 12 and 24 hours | No statistically significant difference | Low |
Return visits, (re)admissions, or both | No statistically significant difference | Low |
Length of stay | No statistically significant difference | GRADE assessment not performed for this outcome |
Additional treatments: epinephrine; supplemental corticosteroids | No statistically significant difference | GRADE assessment not performed for this outcome |
Additional treatments: intubation/tracheostomy | No events in either treatment group | GRADE assessment not performed for this outcome |
Adverse events | See note ᶜ | Low |
Improvement | - | None of the studies identified by the review assessed this outcome |
Note ᵃ The sample size for the comparison corticosteroid versus epinephrine was too small to allow the reviewers to make any definite conclusions. ᵇ Results reported narratively (13 RCTs with 1399 participants reported on adverse effects [including pneumonia, pneumonitis, neutropenia, and exacerbated symptoms]); see the Cochrane Clinical Answer (CCA) for more details. ᶜ Results reported narratively (three RCTs with 162 participants reported on adverse effects with corticosteroids; one study reported five cases of secondary bacterial infections which required antibiotic therapy; one reported four cases of tremor and tachycardia and the third reported no serious adverse effects).
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 children with croup, how do glucocorticoids compare with placebo or epinephrine for improving outcomes?
- What are the effects of nebulized epinephrine in children with croup?
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