Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia
Authors: Reed A.C. Siemieniuk, Pablo Alonso-Coello, Gordon H. Guyatt
Journal: Annals of Internal Medicine (2016)

Letters3 May 2016Corticosteroid Therapy for Patients Hospitalized With Community-Acquired PneumoniaReed A.C. Siemieniuk, MD, Pablo Alonso-Coello, MD, PhD, and Gordon H. Guyatt, MD, MScReed A.C. Siemieniuk, MDFrom McMaster University, Hamilton, Ontario, Canada, and Instituto de Investigación Biomédica (Sant Pau)–CIBER de Epidemiología y Salud Pública, Barcelona, Spain.Search for more papers by this author, Pablo Alonso-Coello, MD, PhDFrom McMaster University, Hamilton, Ontario, Canada, and Instituto de Investigación Biomédica (Sant Pau)–CIBER de Epidemiología y Salud Pública, Barcelona, Spain.Search for more papers by this author, and Gordon H. Guyatt, MD, MScFrom McMaster University, Hamilton, Ontario, Canada, and Instituto de Investigación Biomédica (Sant Pau)–CIBER de Epidemiología y Salud Pública, Barcelona, Spain.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0583 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The widely used DL method for summarizing random effects (1) has been criticized for sometimes having inappropriately narrow CIs and high type I error rates (2, 3). The HKSJ method, which is based on a t-distribution, is a popular alternative because it is straightforward and does not require familiarity with advanced statistical programs (3).We agree with Drs. Singh and Jaiswal that the HKSJ 95% CIs are implausibly narrow in the mechanical ventilation subgroup analysis, especially in the subgroup of studies enrolling patients with more severe pneumonia. This led to a statistically significant interaction between pneumonia severity and ...References1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-88. [PMID: 3802833] CrossrefMedlineGoogle Scholar2. Cornell JE, Mulrow CD, Localio R, Stack CB, Meibohm AR, Guallar E, et al. Random-effects meta-analysis of inconsistent effects: a time for change. Ann Intern Med. 2014;160:267-70. [PMID: 24727843] LinkGoogle Scholar3. IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol. 2014;14:25. [PMID: 24548571] doi:10.1186/1471-2288-14-25 CrossrefMedlineGoogle Scholar4. Röver C, Knapp G, Friede T. Hartung-Knapp-Sidik-Jonkman approach and its modification for random-effects meta-analysis with few studies. BMC Med Res Methodol. 2015;15:99. [PMID: 26573817] doi:10.1186/s12874-015-0091-1 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From McMaster University, Hamilton, Ontario, Canada, and Instituto de Investigación Biomédica (Sant Pau)–CIBER de Epidemiología y Salud Pública, Barcelona, Spain.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=M15-0715. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia Reed A.C. Siemieniuk , Maureen O. Meade , Pablo Alonso-Coello , Matthias Briel , Nathan Evaniew , Manya Prasad , Paul E. Alexander , Yutong Fei , Per O. Vandvik , Mark Loeb , and Gordon H. Guyatt Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia Meenu Singh and Nishant Jaiswal Metrics Cited byCosyntropin testing does not predict response to glucocorticoids in community‐acquired pneumonia in a randomized controlled trialGuidelines for the Evaluation and Treatment of Pneumonia 3 May 2016Volume 164, Issue 9Page: 636-637KeywordsConflicts of interestCorticosteroid therapyDisclosureGrading of Recommendations Assessment Development and EvaluationPneumoniaVentilators ePublished: 3 May 2016 Issue Published: 3 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...