The Arguments Against

Dr. Anthony G. Crocco

Why listen to me?

•Deputy Chief - McMaster Children’s Hospital ER

•Pediatric Consultant - BEEM

•Tutor - EBCP Course

•Member - PERC

•International Educator

•No industry sponsorship

The Argument Against

•Research problems:

1.How the evidence was presented

2.Risk of the unknown

•A researcher’s story

•The true value of this paper

Plint - 2009

•“Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions.”

Plint - 2009

Plint - 2009

•“Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may (NOT) significantly reduce hospital admissions.”

Plint - 2009

•“our results should be considered exploratory”

•“confirmation of our findings by a study powered specifically to compare combined epinephrine and dexamethasone therapy with placebo is needed”

Steroids safe?

Steroids safe?

•False belief that systemic steroids in premature infants was safe

•Developmental delay (Barrington 2001)

Steroids safe?

•False belief that inhaled steroids had no effect on long-term height

•1.2cm difference (Kelly 2012)

Steroids safe?

A Researcher’s Story...

•What would you do if...?

The True Value

•Exciting and unexpected synergy between epinephrine and steroid use

•Clinically confirms evolving understanding of cellular receptors

•Future work needs to be done to find the lowest, shortest and safest dosing

Conclusions•Results that may benefit, may not

benefit!

•No confidence lines? No confident results!

•First do no harm! Beware of myopia!

•The researchers are not suggesting routine use and would not use it on their own family!

The Arguments Against

Dr. Anthony G. Crocco