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Letters | May 6, 2009

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children

Joel B. Gunter, MD; J. Paul Willging, MD; Charles M. Myer, MD

JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.575.

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To the Editor: We are concerned about inappropriate methodological and analytical approaches in the study by Dr Czarnetzki and colleagues¹ that may have led the authors to conclusions regarding post-tonsillectomy hemorrhage and dexamethasone that are not supported by their data. First, many determinants of post-tonsillectomy hemorrhage, including diagnosis, surgical technique, and administration of ibuprofen, were not standardized. The authors' ability to control for these confounders using multivariable logistic regression was limited by the small number of events. Four of 8 participants requiring surgical re-exploration for hemorrhage did so on the day of surgery; in the absence of coagulopathy (intrinsic or iatrogenic), acute hemorrhage is usually due to surgical technique.²

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May 6, 2009

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children

Dirk Beutner, MD; Caroline Koll, MD

JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.573.

May 6, 2009

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children

Jae Il Shin, MD

JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.574.

May 6, 2009

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children—Reply

Christoph Czarnetzki, MD, MBA; Nadia Elia, MD, MSc; Martin R. Tramèr, MD, DPhil

JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.576.

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Gunter JB, Willging J, Myer CM. Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children. JAMA. 2009;301(17):1764-1766. doi:10.1001/jama.2009.575.

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