{Steroids for croup}
by Jeffrey Hom, MD and David H Newman, MD
Q: Do glucocorticoids prevent return visits, admissions, or need for additional treatment?
A: YES
NNT
5
NNH
No harms were
identified
Color
Green: Proven to benefit
Take Home Message: Steroids appear to substantially improve respiratory status and also to prevent return visits in children with croup.
Details: Croup accounts for a significant number of ED visits and hospital admissions. This Cochrane review included 41 trials from the inpatient and outpatient setting, most using dexamethosone. Ten trials examined return visits and admission rates in 1679 subjects, showing a decrease of 9.2%, or an NNT of 11.
There were 17 trials assessing the need for rescue therapy. Airway management, antibiotics, additional glucocorticoids, and mist tent use were all unaffected. However epinephrine as a rescue therapy was reduced by 10% (NNT = 10).
Caveats: The 9.2% absolute reduction in readmissions (NNT=11) is impressive, but is based on a 21% overall rate of readmission in children in the control groups. The actual benefit for a child will depend upon how often croup children are readmitted at baseline in one’s institution. The Cochrane authors note that in their group of studies the average readmission rate among institutions was roughly 12%, which would suggest an average NNT of 17 (seventeen patients would need to be treated to prevent one readmission).
Data source: Russell KF, Liang Y, O’Gorman K, Johnson DW, Klassen TP. Glucocortocoids for croup. Cochrane Database of Systematic Review. 2011, Issue 1.
“These are standard practices; why do I need to know the NNT?”
The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one patient. The concept is statistical, but intuitive. After all, we know that not everyone is helped by a medicine or intervention—some benefit, some are harmed, and some are unaffected. The NNT and the NNH (number-needed-to-harm) tell us how many. TheNNT.com is a project designed to make these estimates available for decisions at the bedside, and in conversations with patients.
David H. Newman, MD is Author of Hippocrates’ Shadow: Secrets From The House Of Medicine