Adverse Events Following Short-Course Systemic Corticosteroids Among Children and Adolescents
Notice bibliographique
Résumé
Importance: Short courses of systemic corticosteroids are used in the management of a number of acute clinical conditions, including Bell palsy, croup, and pneumonia, but research on associations of corticosteroid use with adverse events (AEs) in children is limited. Objective: To document AEs associated with short-term (≤14 days) use of systemic corticosteroids in children and adolescents (1 to younger than 18 years) across different clinical conditions. Data Sources: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to February 2025. Reference lists of eligible articles and related systematic reviews were also searched. Study Selection: Randomized clinical trials evaluating AEs (any unfavorable and unintended signs, symptoms, or syndromes that occurred during the period of using an investigational product) after use of short-course systemic corticosteroids in children and adolescents were included. Data Extraction and Synthesis: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline, pairs of reviewers independently reviewed abstracts, extracted data, and assessed risk of bias of eligible trials. Pairwise, fixed-effects meta-analyses were performed using Mantel-Haenszel methods with risk difference (RD). Main Outcomes and Measures: The primary outcomes were serious AEs (events resulting in death, life-threatening conditions, hospitalization, or substantial disability), AEs leading to discontinuation, hyperglycemia, sleep disturbances, change in behavior, and gastrointestinal bleeding. RDs were reported as AEs per 1000 patients with 95% CIs. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence (high, moderate, low, or very low certainty). Results: A total of 45 eligible trials that included 6470 children (mean [SD] age, 5.57 [3.62] years; 3753 male [58%]) were identified. In pooled analysis, there was moderate certainty evidence that compared with usual care, corticosteroids were not associated with serious AEs (RD, 1 fewer AE per 1000 patients [95% CI], 9 fewer to 7 more AEs per 1000 patients]), AEs leading to discontinuation (RD, 4 more AEs per 1000 patients [95% CI, 3 fewer to 11 more AEs per 1000 patients]), or change in behavior (RD, 8 more AEs per 1000 patients [95% CI, 5 fewer to 21 more AEs per 1000 patients]). With moderate certainty evidence, corticosteroids were associated with an increased risk of hyperglycemia (RD, 38 more AEs per 1000 patients [95% CI, 11 to 64 more AEs per 1000 patients]) and sleep problems (RD, 15 more AEs per 1000 patients [95% CI, 1 to 28 more AEs per 1000 patients]). Corticosteroid use was also associated with an increased risk of gastrointestinal bleeding (RD, 13 more per AEs per 1000 patients [95% CI, 3 to 23 more AEs per 1000 patients]), but the certainty of evidence was low. Conclusions and Relevance: In this systematic review and meta-analysis of randomized trials, there was moderate certainty evidence that corticosteroids were associated with an increased risk of hyperglycemia and sleep problems and low certainty evidence that corticosteroids were associated with increased risk of gastrointestinal bleeding, but these AEs were very seldom serious. These findings suggest that an individualized approach to short-term corticosteroid use may be warranted and that further research is needed to obtain better quality of evidence.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».