Oral steroids for preschool children with acute wheeze: a systematic review and meta-analysis

Résumé fourni par la source

Background: Benefits of oral corticosteroids (OCS) for acute preschool wheeze are unclear. Aim: Systematically review evidence for OCS in preschool children presenting to the emergency department (ED) or hospitalised with acute wheeze. Methods: We included randomised controlled trials of OCS vs placebo for children <6 years with acute wheeze. Primary outcomes were hospitalisation risk and length of stay (LOS; we prespecified a difference of 4 hours as clinically relevant). Secondary outcomes included reattendance and need for PICU. Two authors extracted data and assessed risk of bias. We extracted subgroup data around factors associated with OCS response. Results: Four studies were eligible. Risk of bias was generally low except for selective outcome reporting. OCS did not reduce risk of hospitalisation (Risk ratio 0.94,95%CI 0.80,1.12; Figure 1). Of 3 studies reporting LOS, 2 showed statistically but not clinically significant reduction (placebo 9 hours [IQR 2-16] vs OCS 6.2 [2–11.8] p0.04; and placebo 7.7 hours[5.0-22.9] versus OCS 6.8[4–14] p0.03). Atopic history, and interval symptoms were not consistently associated with better response to OCS. Severity and prior diagnosis of asthma were associated with response in one study. Conclusion: High quality evidence suggests OCS should not be used in the ED in acute preschool wheeze. Effects on those with known asthma or hospitalised with severe illness are uncertain.

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