Harms of short-course systemic corticosteroids among children and adolescents: a systematic review and meta-analysis of randomized controlled trials
Bibliographic record
Abstract
Abstract Introduction Short courses of systemic corticosteroids are used in the clinical management of a number of acute clinical conditions. In this systematic review and meta-analysis of randomized controlled trials we document the harms of the short-term use (≤ 14 days) of systemic corticosteroids in children and adolescents (1-18 years old) across different clinical conditions. Methods We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to January 2024 for randomized controlled trials evaluating the harms of short-course systemic corticosteroids We performed pairwise meta-analyses using the Mantel-Haenszel methods with risk difference. We assessed the certainty of evidence using the GRADE approach and subgroup analysis credibility with the ICEMAN instrument. PROSPERO registration (CRD42023400934). Results We identified 45 trials that included 6,470 children. Corticosteroids probably cause few if any serious adverse events (RD 1 fewer per 1000 [95% CI 9 fewer to 7 more]; moderate certainty), but probably do result in adverse events leading to discontinuation (RD 4 more per 1000 [95%CI 3 fewer to 11 more]; moderate certainty) compared to usual care. Corticosteroids probably increase the risk of hyperglycemia (RD 38 more per 1000 [95%CI 11 to 64 more]; moderate certainty), sleep problems (RD 15 more [95% CI 1 to 28 more]; moderate certainty), change in behavior (RD 8 more [95% CI 5 fewer to 21 more]; moderate certainty) and gastrointestinal bleeding (RD 13 more per 1000 [95% CI 3 to 23 more]; moderate certainty). Conclusion Corticosteroids likely increase the risk of hyperglycemia, sleep problems, change in behavior and gastrointestinal bleeding, but these adverse events are very seldom if ever serious.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.076 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.041 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".