Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Children or adults with acute bacterial meningitis ᵃ
Intervention: Glycerol with or without corticosteroids ᵇ
Comparison: Placebo with or without corticosteroids ᵇ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Mortality (follow‐up up to 6 months) | No statistically significant difference | Moderate |
Neurological disability (follow‐up 40 days to 6 months) | No statistically significant difference | Low |
Seizures (follow‐up 40 days to 6 months) | No statistically significant difference | Low |
Hearing loss (follow‐up 40 days to 6 months) | Favours intervention ᶜ | Moderate |
Adverse effects: nausea, vomiting, diarrhoea | No statistically significant difference | Very Low |
Adverse effects: gastrointestinal bleeding | No statistically significant difference | Moderate |
Note The Cochrane Review which underpins this Cochrane Clinical Answer (CCA) notes that glycerol may provide a small beneficial effect for deafness in children. However, further research is required. ᵃ Of the five included studies four were in children (age range 2 months to 16 years) and one in adults (age range not reported). See CCA for more details. ᵇ All participants received broad-spectrum antibiotics. ᶜ Subgroup analysis found no statistically significant difference between groups for participants who received corticosteroids. See CCA for more details.
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a systematic review that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and there is no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Critically ill adults in intensive care units or high dependency units
Intervention: Balanced crystalloid solution
Comparison: Normal saline
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
All-cause mortality at 90 days ᵃ | No statistically significant difference ᵇ | High |
Incidence of acute kidney injury | No statistically significant difference | Moderate |
New treatment with renal replacement therapy | No statistically significant difference | Low |
Ventilator-free days (to day 28) | No statistically significant difference | Moderate |
Vasopressor-free days (to day 28) | No statistically significant difference | High |
Health-related quality of life | See note ᶜ | GRADE assessment not performed for this outcome |
Note The reviewers noted that the limitations of this review are mostly related to the characteristics of the included trials, which reported outcomes at different time points and used different definitions for outcome measures such as acute kidney injury. Furthermore, many of the studies did not include or did not report outcomes in subgroups of interest, resulting in limited power to detect clinically important subgroup effects. None of the included studies reported on longer-term quality of life or functional outcomes. ᵃ Primary outcome as stated in the systematic review underpinning this evidence table. ᵇ The estimated effect of balanced crystalloids versus normal saline ranges from a 9% relative reduction to a 1% relative increase in the risk of death; high probability that the average effect of using balanced crystalloids was to reduce mortality; RR 0.96 (95% CI 0.91 to 1.01). The reviewers noted that this estimate of effect was stable when including low risk-of-bias studies only or when including all studies regardless of risk-of-bias. The authors of the systematic review also noted that reduction in mortality was significant if a Bayesian approach was taken. ᶜ No data was available to provide a pooled estimate of quality of life.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- In adults with acute bacterial meningitis, is adding corticosteroids to standard treatment with antibacterial agents helpful?
- How does glycerol compare with placebo for people with acute bacterial meningitis treated with antibiotics?
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