Le 17/05/2009 00:16, Charles Brault a écrit :
Epinephrine
and Dexamethasone in Children with Bronchiolitis
Amy C. Plint, M.D., M.Sc., David W.
Johnson, M.D., Hema Patel, M.D., M.Sc., Natasha Wiebe, M.Math., Rhonda
Correll, H.B.Sc.N., Rollin Brant, Ph.D., Craig Mitton, Ph.D., Serge
Gouin, M.D., Maala Bhatt, M.D., M.Sc., Gary Joubert, M.D., Karen J.L.
Black, M.D., M.Sc., Troy Turner, M.D., Sandra Whitehouse, M.D., Terry
P. Klassen, M.D., M.Sc., for Pediatric Emergency Research Canada (PERC)
ABSTRACT
Background Although numerous
studies have explored the benefit of using nebulized
epinephrine or corticosteroids alone to treat infants with
bronchiolitis, the effectiveness of combining these medications
is not well established.
Methods We conducted a
multicenter, double-blind, placebo-controlled trial in
which 800 infants (6 weeks to 12 months of age) with bronchiolitis
who were seen in the pediatric
emergency department were randomly assigned to one
of four study groups. One group received two treatments of
nebulized epinephrine (3 ml of epinephrine in a 1:1000
solution per treatment) and a total of six oral doses of
dexamethasone (1.0 mg per kilogram of body weight in the
emergency department and 0.6 mg per kilogram for an additional 5
days) (the epinephrine–dexamethasone group), the second group
received nebulized epinephrine and oral placebo (the epinephrine group),
the third received nebulized placebo and oral dexamethasone (the
dexamethasone group), and the fourth received nebulized placebo
and oral placebo (the placebo group). The primary outcome was
hospital admission within 7 days after the day of enrollment (the
initial visit to the emergency department).
Results Baseline clinical
characteristics were similar among the four groups. By the
seventh day, 34 infants (17.1%) in the epinephrine–dexamethasone
group, 47 (23.7%) in the epinephrine group, 51 (25.6%) in
the dexamethasone group, and 53 (26.4%) in the placebo
group had been admitted to the hospital. In the unadjusted
analysis, only the infants in the epinephrine–dexamethasone group
were significantly less likely than those in the placebo group
to be admitted by day 7 (relative risk, 0.65; 95% confidence interval,
0.45 to 0.95, P=0.02). However, with adjustment for multiple comparisons,
this result was rendered insignificant (P=0.07). There were
no serious adverse events.
Conclusions
Among infants with bronchiolitis treated in the emergency
department, combined therapy with dexamethasone and epinephrine
may significantly reduce hospital admissions. (Current
Controlled Trials number, ISRCTN56745572 [controlled-trials.com]
.)
Source Information
The authors' affiliations are listed in the
Appendix.
Address reprint requests to Dr. Plint at the Children's Hospital of Eastern
Ontario, 401 Smyth Ave., Ottawa, ON K1H 8L1, Canada, or at [email protected]
.
http://content.nejm.org/cgi/content/abstract/360/20/2079
quelqu'un qui comprend cet étrange langage peut il expliquer clairement
comment on peut dire qu'après ajustement le resultat est
"insignificant" (non signifiant ?) et dire 2 lignes plus tard que ça
peut (may) diminuer significativement les hospitalisations
est ce ma compréhension de l'anglais (fort possible), du langage
statistique (encore plus possible) ou alors ce sont les auteurs qui
font des conclusions qui leur plaisent ?
merci
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différence entre l'homme politique et l'homme d'État
est la suivante : le premier pense à la prochaine élection,
le second à la prochaine génération".
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Freeman Clarke (1810-1888)
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