title: The effectiveness of glucocorticoids in treating croup: meta-analysis.
abstract: OBJECTIVE
  To determine the effectiveness of glucocorticoid treatment in children with croup.
  
  
  METHODS
  Meta-analysis of randomized controlled trials that examine the effectiveness of glucocorticoid treatment in children with croup.
  
  
  METHODS
  Score on scale measuring severity of croup,use of co-interventions (epinephrine, antibiotics, or supplemental glucocorticoids), length of stay in the emergency department or the hospital, and rate of hospitalization.
  
  
  RESULTS
  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 [CI] -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 epinephrine treatments needed in children treated with glucocorticoids: a decrease of 9% (95% CI 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 the emergency department (-11 hours, 95% CI -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.
  
  
  CONCLUSIONS
  Dexamethasone and budesonide are effective in relieving the symptoms of croup as early as 6 hours after treatment. Fewer co-interventions are used, and the length of time spent in the hospital is decreased in patients treated withglucocorticoids.
authors.affiliation: Center for Systematic Reviews, CHEO Research Institute, 401 Smyth Road, Ottowa, Ontario, Canada KIH 8L1.
authors.forename: M
authors.initials: M
authors.lastname: Ausejo
authors.forename: A
authors.initials: A
authors.lastname: Saenz
authors.forename: B
authors.initials: B
authors.lastname: Pham
authors.forename: D
authors.initials: D
authors.lastname: Moher
authors.forename: T C
authors.initials: TC
authors.lastname: Chalmers
authors.forename: J D
authors.initials: JD
authors.lastname: Kellner
authors.forename: D W
authors.initials: DW
authors.lastname: Johnson
authors.forename: T P
authors.initials: TP
authors.lastname: Klassen