An updated Cochrane review included 38 studies with a total of 4 299 subjects. Glucocorticoid treatment (mostly dexamethasone or nebulized budesonide) was associated with an improvement in the Westley score at six hours with a mean difference of -1.2 (95% CI -1.6 to -0.8) and at 12 hours -1.9 (95% CI -2.4 to -1.3); at 24 hours this improvement was no longer significant (-1.3, 95% CI -2.7 to 0.2). Fewer return visits and/or (re)admissions occurred in patients treated with glucocorticoids (RR 0.5, 95% CI 0.3 to 0.7). Length of time spent in accident and emergency or hospital (mean difference 12 hours, five to 19 hours) was significantly decreased for patients treated with glucocorticoids. Use of epinephrine decreased for children treated with a glucocorticoid (risk difference 10%, 95% CI 1 to 20). The generally small numbers of patients in each study and confounding variables made it difficult to make definitive recommendations regarding the superiority of dexamethasone or budesonide, dose or route of administration. The authots state that in the absence of further evidence, a single oral dose of dexamethasone, probably 0.6 mg/kg, should be preferred because of its safety, efficacy and cost-effectiveness. In a child who is vomiting, nebulized budesonide or intramuscular dexamethasone might be preferable.
The following decision support rules contain links to this evidence summary: