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Epinephrine and Dexamethasone in Children with Bronchiolitis

(WikiMedia Commons - James Heilman, MD)
Landmark Series
Methodology Score: 4.5/5 
Usefulness Score: 4/5
Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, Mitton C, Gouin S, Bhatt M, Joubert G, Black KJ, Turner T, Whitehouse S, Klassen TP; Pediatric Emergency Research Canada (PERC).
N Engl J Med. 2009 May 14;360(20):2079-89


This prospective, multicenter, double-blind randomized trial of 800 infants found a synergistic effect between epinephrine and dexamethasone for the treatment of acute bronchiolitis and that, together, they lower admission rates at seven days, although the primary analysis was not significant after adjustment (RRR of 35%, RR 0.64, [95% CI 0.37-1.15]). The group agreed that although an important effect was noted, there are still some issues with the dosage of dexamethasone used and therefore the optimal dosing of both epinephrine and dexamethasone would have to be further examined. 
By: Dr. Qamar Amin
(Presented April 2012)


Epi Lesson – Adjustment Analyses in Randomized Trials
Clinical trials depend upon random allocation to ensure good balance of important baseline characteristics and thus allow a fair comparison between study arms, usually by unadjusted statistical analyses. Commonly, additional secondary analyses will adjust for all important measured covariates using multivariate techniques like logistic regression. These usually confirm the findings of the primary analyses but can only be considered hypothesis generating when the secondary analyses results are different. 
By: Ian Stiell

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