RT Journal
A1 Horner D, Bartram T, Jenner R, Morton R
T1 CAn the efficacy of hypertonic saline in bronchiolitis truly be assessed with a short-term primary outcome?
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2010
FD April 1
VO 164
IS 4
SP 395
OP 395
DO 10.1001/archpediatrics.2010.36
UL http://dx.doi.org/10.1001/archpediatrics.2010.36
AB 
Although the trial was adequately powered to detect what was thought to be a clinically significant decrease in the Respiratory Assessment Change Score (RACS) during 120 minutes, we take issue with this as the primary outcome for 2 reasons. First, much of the data used in the Cochrane review2 was based on assessment of severity scores at more delayed intervals, such as 24 and 48 hours posttreatment. In the pooled data at these stages, a statistically significant decrease in severity score was seen in the hypertonic saline group. We suggest that in many patients, 120 minutes is too short to see meaningful improvement in a mild to moderate case of bronchiolitis. Therefore the results from Grewal et al may be misleadingly pessimistic. Second, we believe that the RACS is an overcomplicated tool to assess treatment benefit, based on its multiple variables, subjective criteria, and lack of nonrespiratory data. We find both the Kristjansson3 and Wang4 clinical respiratory scores easier to use and more comprehensive assessments of morbidity.