The effectiveness of glucocorticoids in treating croup: meta-analysis

Objective To determine the effectiveness of glucocorticoid treatment in chi ldren with croup. Design Meta-analysis of randomised controlled trials that examine the effec tiveness of glucocorticoid treatment in children with croup. Main outcome measures Score on scale measuring severity of croup, use of co interventions (adrenaline (epinephrine), antibiotics, or supplemental gluco corticoids), length of stay in accident and emergency or in hospital, and r ate of hospitalisation. Results Twenty four studies met the inclusion criteria. Glucocorticoid trea tment was associated with an improvement in the croup severity score at 6 h ours 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 longe r significant (-1.0, - 2.0 to 0.1). There was a decrease in the number of a drenaline treatments needed in children treated with glucocorticoids: a dec rease of 9% (95% confidence interval 2% to 16%) among those treated with bu desonide and of 12% (4% to 20%) among those treated with dexamethasone. The re was also a decrease in the length of time spent in accident and emergenc y (-11 hours, 95% confidence interval -18 to 4 hours), and for inpatients h ospital stay was reduced by 16 hours (-31 to 1 hour). Publication bias seem s to play a part in these results. Conclusions Dexamethasone and budesonide are effective in relieving the sym ptoms of croup as early as 6 hours after treatment Fewer cointerventions ar e used and the length of time spent in hospital is decreased in patients tr eated with glucocorticoids.