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Study flow diagram.
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Figure 1

Study flow diagram.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 1 Admissions.
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Analysis 1.1

Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 1 Admissions.

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Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 2 Length of stay.
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Analysis 1.2

Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 2 Length of stay.

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Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 3 Pulse rate at 2 hours.
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Analysis 1.3

Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 3 Pulse rate at 2 hours.

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Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 4 Clinical Failure.
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Analysis 1.4

Comparison 1 IV + inhaled beta agonist vs. inhaled beta‐agonist, Outcome 4 Clinical Failure.

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Summary of findings for the main comparison. IV + inhaled beta agonist compared with inhaled beta‐agonist for acute asthma

IV + inhaled beta agonist compared to inhaled beta‐agonist for acute asthma

Patient or population: patients with acute asthma
Settings: ED and ICU
Intervention: IV + inhaled beta agonist
Comparison: inhaled beta‐agonist

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

inhaled beta‐agonist

IV + inhaled beta agonist

Admissions to hospital

54 per 100

25 per 100
(7 to 62)

OR 0.29
(0.06 to 1.38)

29
(1 study)

⊕⊕⊝⊝
low1

Length of stay in emergency department

mean control group stay was 57 (SD 56) minutes

The mean length of stay in the intervention groups was
12.95 minutes lower
(38.74 lower to 12.84 higher)

MD ‐12.95 (‐38.74 to 12.84)

46
(1 study)

⊕⊕⊕⊝
moderate2

Pulse rate at 2 hours

the mean heart rate in the control group was 142 (SD 10)

The mean heart rate at 2 hours in the intervention groups was
10 beats per minute higher
(1.07 lower to 21.07 higher)

MD 10.00 (‐1.07 to 21.07)

29
(1 study)

⊕⊕⊕⊝
moderate2

Clinical Failure

(children with a severe to moderate overall clinical assessment score at two hours)

93 per 100

56 per 100
(22 to 84)

OR 0.09
(0.02 to 0.38)

29
(1 study)

⊕⊕⊕⊝
moderate2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Admissions: one point deducted for risk of bias due to lack of clarity in randomisation and blinding procedures, and an additional point deducted as data contributed by only one study

2 An additional point deducted as data contributed by only one study

Figuras y tablas -
Summary of findings for the main comparison. IV + inhaled beta agonist compared with inhaled beta‐agonist for acute asthma
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Comparison 1. IV + inhaled beta agonist vs. inhaled beta‐agonist

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Admissions Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Length of stay Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Pulse rate at 2 hours Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Clinical Failure Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. IV + inhaled beta agonist vs. inhaled beta‐agonist
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