JOURNAL APPRAISAL

DANICE FAITH B. ALOMBRO

Y1 INFECTIOUS DISEASE FELLOW
OBJECTIVES
• Execute a Literature Search based on the clinical question
• Demonstrate how to critically appraise a meta-analysis
• Interpret the results based on the available evidence
• Formulate a conclusion/recommendation based on the overall findings
 A.A.
71/F

DYSPNEA
HISTORY OF PRESENT ILLNESS

2 DAYS PTA 1 DAYS PTA

Fever Decrease in sensorium

Cough
Malaise
Progressive DOB
 PMHx FHx PSHx

Hypertensive maintained on Noncontributory Nonsmoker

Losartan 50mg/tab 1 tab OD
(+) PTB BC, Cat I treatment 30
Nonalcoholic
years ago beverage drinker
(+) PTB relapse CD Cat I treatment Previously a paralegal
20 years ago
COVID Vaccination: Sinovac x 3
 PHYSICAL EXAM

Awake, weak-looking, in distress

110/70, 86bpm, 25cpm, O2Sat: 89-90% on 6lpm via FM-->
BIPAP at FiO2 30
Anicteric sclerae, pink palpebral conjunctiva , (-)CLADs
ECE (+) crackles, R LF
Soft abdomen, non-tender
(-)edema
CBC
HGB 146 HCT 0.44 WBC 27.9 PC 203 N89 L3 M8 E0
B0
 ASSESSMENT
CAP-HR
Hypertension St I, unknown control
PTB BC, Cat I treatment completed
(1993)
PTB relapse CD Cat I treatment
completed (1999)
 Among adults diagnosed with Severe
Community Acquired Pneumonia, how
effective are steroids in preventing
mortality?
CLINICAL QUESTION
#1: corticosteroids
#2: community acquired
pneumonia
#3: mortality
APPRAISING
DIRECTNESS
 Clinical Question Study

P Patient with diagnosed with CAP- Patients with severe pneumonia

HR

E Corticosteroids Corticosteroids

C No corticosteroids No corticosteroids

O Mortality All cause Mortality

M RCT/Systematic Review and Meta- Meta-Analysis

Analysis
APPRAISING
VALIDITY
Q1: WERE THE CRITERIA FOR INCLUSION
OF STUDIES APPROPRIATE?
Q2: WAS THE SEARCH FOR ELIGIBLE
STUDIES THOROUGH?
PubMed, Cochrane Library and Embase
The Boolean search strategy was as follows:
((pneumonia OR lower respiratory chest infection OR LRTI [lower respiratory tract infection] OR chest
infection) AND (steroid OR corticoid OR prednisolone OR hydrocortisone OR dexamethasone OR
solumedrone) AND (clinical trial OR randomized controlled trial or controlled trial) NOT (COVID OR
viral)).
Q2: WAS THE SEARCH FOR ELIGIBLE
STUDIES THOROUGH?
Q3: WAS THE VALIDITY OF THE INCLUDED
STUDIES ASSESSED?
Therapy (Validity Criteria)
Were patients randomly assigned to treatment groups? Was allocation concealed?

Were baseline characteristics similar at the start of the trial?

Were patients blinded to the treatment assignment?

Were caregivers blinded to treatment assignment? Were outcome assessors blinded to the treatment
assignment?

Were all patients analysed in the groups they were originally randomized?
Q3: WAS THE VALIDITY OF THE INCLUDED
STUDIES ASSESSED?
Q4: WERE THE ASSESSMENTS OF THE
STUDIES REPRODUCIBLE?
APPRAISING
RESULTS
Q1: WHAT ARE THE OVERALL RESULTS OF
THE REVIEW?
Q2: WERE THE RESULTS SIMILAR FROM
STUDY TO STUDY?
Q3: HOW PRECISE WERE THE RESULTS
APPRAISING
APPLICABILITY
Q3: BIOLOGIC ISSUES
SEX
- No issues

COMOBIDITIES
- No issues

RACE
- Most studies were done in Western countries.
Q3: BIOLOGIC ISSUES
Biologic Issues affecting applicability:

AGE
- No issues

PATHOLOGY
- No issues
SOCIOECONOMIC

Dexamethasone 5mg/mL Php 51.52

Hydrocortisone 100mg ampoule Php 20.50
Prednisone 20mg tab Php 8.75
Methylprednisone 16mg tab Php 41.75
INDIVIDUALIZING RESULTS

No significant difference was found in mortality

between patients receiving adjuvant corticosteroid ARR= 10.8- 9.5
therapy compared with standard care ARR= 1.3 % OR 0.013
(9.5% vs 10.8%; RR, 0.85 [95% CI, 0.67- 1.07])

NNT= NNT= NNT=77

CONCLUSION
• The use of steroids does not significantly decrease mortality for patients with severe Community
Acquired Pneumonia.

• We recommend against the use of corticosteroids among patients with severe Community Acquired
Pneumonia.