The findings of this high quality Cochrane review
(n=4,565 children) reinforce current recommendations and practice with a moderate degree of certainty. They suggest that corticosteroids rapidly
reduce symptoms of croup in children, within about 2 hours and that the effect lasts for at least 24 hours. Corticosteroids included beclomethasone,
betamethasone, budesonide, dexamethasone, fluticasone, and prednisolone. Most studies compared corticosteroids to placebo, although some compared
them to adrenaline, to another corticosteroid, or combination of corticosteroids; or compared corticosteroids given in different ways, or amounts.
The findings may support earlier escalation of therapy. Shorter hospital stays and the reduction in readmission rates from about 20% to 10% are
important outcomes. Few studies had a low overall risk of bias, and many biases were unclear from the reporting. However, using the GRADE system
the certainty of evidence was thought to be moderate meaning that readers can be moderately confident in the effect estimate.
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