Meenu Singh, MD; Nishant Jaiswal, MBBS
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=L15-0582.
Singh M, Jaiswal N. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia. Ann Intern Med. 2016;164:636. doi: 10.7326/L15-0582
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Published: Ann Intern Med. 2016;164(9):636.
TO THE EDITOR:
We read Siemieniuk and colleagues' recent review and meta-analysis (1), which states that, in light of evidence with moderate to high certainty, systemic corticosteroids were helpful in adults with community-acquired pneumonia (CAP). The effect estimates obtained were significant and precise. We disagree, however, with the methods chosen to draw the 95% CIs and the variation in interpreting the results of the analysis of the effect of systemic corticosteroids on the need for mechanical ventilation in patients hospitalized with CAP. The authors used Hartung–Knapp–Sidik–Jonkman (HKSJ) modification (2), which is the preferred approach when more than 5 studies are included in an analysis. But the analyses, shown in Figures 2 and 3 of the meta-analysis (1), included 5 studies or fewer. This method has limitations when there were 5 or fewer studies and when those studies are of various sample sizes (2). A sensitivity analysis using the DerSimonian–Laird (DL) method (3) was actually required, and the effect estimates should be interpreted by comparing these 2 methods.
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