title: Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis.
abstract: Summary In children undergoing tonsillectomy, dexamethasone is recommended to reduce the risk of postoperative nausea and vomiting while non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief. We aimed to determine whether children who receive dexamethasone or dexamethasone with NSAID are more likely to experience haemorrhage post-tonsillectomy. Randomized and non-randomized studies in which children undergoing tonsillectomy received dexamethasone or dexamethasone and NSAID were sought within bibliographic databases and selected tertiary sources. The risk of bias assessment and evaluation of haemorrhage rate data collection and reporting were assessed using the Cochrane Risk of Bias Tool and McHarm tool. Synthesis methods comprised pooled estimate of the effect of dexamethasone on the risk of haemorrhage rate using the Peto odds ratio (OR) method. The pooled estimate for haemorrhage rate in children who received dexamethasone was 6.2%, OR 1.41 (95% confidence interval 0.89-2.25, P=0.15). There was risk of bias and inconsistent data collection and reporting rates of haemorrhage in many of the included studies. Clinical heterogeneity was observed between studies. The pooled analysis did not demonstrate a statistically significant increase in the risk of post-tonsillectomy haemorrhage with dexamethasone with/without NSAID use in children. However, the majority of the included studies were not designed to investigate this endpoint, and thus large studies which are specifically designed to collect data on haemorrhage rate are needed.
authors.affiliation: Research and Development, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK jennifer.bellis@alderhey.nhs.uk.
authors.forename: J R
authors.initials: JR
authors.lastname: Bellis
authors.affiliation: Department of Molecular and Clinical Pharmacology, University of Liverpool, Ashton Street, Liverpool L69 3GE, UK.
authors.forename: M
authors.initials: M
authors.lastname: Pirmohamed
authors.affiliation: Department of Women's and Children's Health, Institute of Translational Medicine (Child Health), University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Nunn
authors.affiliation: Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
authors.forename: Y K
authors.initials: YK
authors.lastname: Loke
authors.affiliation: Department of Paediatric Otolaryngology, Head and Neck Surgery, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
authors.forename: S
authors.initials: S
authors.lastname: De
authors.affiliation: Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
authors.forename: S
authors.initials: S
authors.lastname: Golder
authors.affiliation: Department of Biostatistics, University of Liverpool, Shelley's Cottage, Brownlow Street, Liverpool L69 3GS, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kirkham
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D014068:Tonsillectomy / Q000009:adverse effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003907:Dexamethasone
keywords: dexamethasone; paediatrics; tonsillectomy