Corticosteroids probably reduce sepsis-related 28-day mortality in adults – unclear effect in children

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This Cochrane Review represents a disappointing summary of recommendations about corticosteroids in sepsis that purport to apply to adults as well as children, despite the fact that the overwhelming amount of evidence was generated in adults. In fact, among 12 192 patients studied across 61 randomized clinical trials, only 533 were children, having been studied across 6 pediatric studies, and 2 mixed adult and pediatric studies. Furthermore, only 390 children studied had sepsis (143 had pneumonia), still further undermining the validity of the recommendations. If the pediatric data are analyzed separately, no mortality effect was observed in any study, which is not surprising given the extremely small size of those 8 studies and the low mortality in pediatric sepsis.1x1Merritt, C., Menon, K., Agus, M.S.D., Choong, K., McNally, D., O’Hearn, K. et al. Beyond survival: pediatric critical care interventional trial outcome measure preferences of families and healthcare professionals. Pediatr Crit Care Med. 2018;
19: e105–e111
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