Abstract
OBJECTIVES: Systematic review of controlled trials of nebulised HS for infants hospitalised with primary acute bronchiolitis.
METHODS: We searched CENTRAL, Medline, Embase, Google Scholar and Web of Knowledge, trial registries and journal indices for published and unpublished literature to March 2014, combining thesaurus and free-text synonyms of saline and bronchiolitis. We included randomised or quasi-randomised trials which compared HS versus either normal saline (+/- adjunct treatment) or no treatment. Two reviewers extracted data to calculate mean differences (MD) length of hospital stay (LoS – primary outcome) clinical severity score (CSS); adverse events with 95% Confidence Intervals (CIs). We investigated statistical heterogeneity using I2.
RESULTS: 15 trials (n=1722), HS reduced mean LoS by 0.41 (95% CI -0.56, -0.27) days (Figure). Risk of bias and high levels of heterogeneity (I2=90%) in the main analysis and one out of four intervention subgroups suggest the result should be treated cautiously. A reduction in CSS (4 trials, n=352, MD -1.37, CI -1.53, -1.21) should also be treated cautiously. None of the trials reported intervention-related serious adverse events. A further RCT, published in June 2014, will be included in the final presentation.
CONCLUSION: Claims that HS achieves small reductions in LoS must be treated with scepticism.
PROSPERO REG: CRD42014007569
FUNDING: National Institute for Health Research
- © 2014 ERS