Does immediate systemic glucocorticoid withdrawal during the treatment of acute exacerbations of chronic obstructive pulmonary disease affect patient mortality when compared to sequential withdrawal?

Objective: To test whether selection bias has affected the reported effect estimate for immediate systemic glucocorticoid withdrawal in comparison to sequential withdrawal (RD 0.00. 95%CI: -0.02 to 0.02), regarding patient mortality during the treatment of acute exacerbations of chronic obstructive pulmonary disease. Method: Trial adjusted, simulated comparator trial (SCT) based I2 test for single randomised controlled trials Result: The estimated selection bias level (B%) of 40% suggests that 31-40% (198 – 256 of 639) of the total trial subjects were non-randomly allocated in favour of one treatment group above the other. This level appears high enough in order to have affected the reported effect estimate. Conclusion: The effect estimate reported by the tested trial suggests no higher mortality risk after the immediate systemic glucocorticoid withdrawal group in comparison to sequential withdrawal. The selection bias level, estimated by use of the trial adjusted, simulated comparator trial (SCT) based I2 test for single RCTs, B% = 40%, appears high enough in order to have affected the reported estimate.