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May 6, 2009

Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children

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

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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