Does short-term (5 days) systemic glucocorticoid treatment decrease mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) when compared to conventional (14 days) treatment?

Objective: To test whether selection bias has affected the reported effect estimate for short-term (5 days) systemic glucocorticoid treatment in comparison to conventional (14 days) treatment (RD -0.01. 95%CI: -0.07 to 0.05), regarding the decrease of mortality in patients with acute exacerbations of COPD. 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% (97 – 125 of 311) 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 a non-significantly lower mortality rate in the short-term (5 days) systemic glucocorticoid treatment group in comparison to conventional (14 days) treatment. 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