corticosteroidsJournal Club Summary

Methodology Score: 4/5                 
Usefulness Score:  3.5/5
Siemieniuk RA, et al.
Ann Intern Med. 2015;163(7):519-528.
This is a well-done systematic review & meta-analysis elucidating whether corticosteroid therapy along with antibiotics benefits patients with community-acquired pneumonia, and incorporates key new studies that were not included in previous reviews.  The authors conclude from the overall low-quality evidence that steroids probably have a small effect on some serious patient-important outcomes (ARDS, mechanical ventilation, duration of hospital stay, time to clinical stability) without much evidence of harm, but it’s unclear whether they affect mortality, and in whom; the group was divided on whether to incorporate this into current practice.
By: Dr. Ashley Krywenky

Epi lesson:

A meta-analysis may attempt to address a compelling clinical dilemma. But one of the key questions to ask when appraising meta-analyses is whether the pooling of the included studies is appropriate. Clinical heterogeneity reflects clinical differences between study populations, the intervention, co-interventions and/or outcomes when pooling studies in meta-analysis. This is distinct from statistical heterogeneity which can be determined by visually assessing the forest plot, measuring the I2statistic or the Cochran’s Q. Always ask yourself if the meta-analysis is combining apples with apples.   
By: Dr. Lisa Calder