The results were sensitive to risk of bias: when studies with an unclear risk of bias were removed, the pooled estimate for the two studies (n=842) at low risk of bias was no longer statistically significant (pooled risk ratio 0.77, 0.56 to 1.07). Subgroup analyses showed non statistically significant differences between studies combining adrenaline with steroids that followed a protocol (pooled risk ratio 0.74, 0.45 to 1.23; one study, n=400) compared with those that did not follow a protocol (0.62, 0.40 to 0.94; four studies, n=520; ratio of risk ratios 1.19, 0.61 to 2.33). An effect of a similar magnitude was shown with combined adrenaline and dexamethasone compared with placebo (35%), but this did not reach significance (P=0.07) (pooled risk ratio 0.65, 0.4 to 1.05; one study, n=400).Fig 2Results from meta analysis of direct comparisons for admission rates from emergency department (day 1 and day 7) in outpatients.

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