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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

We believe that if more appropriate statistical approaches had been used, the association between increased hemorrhage and dexamethasone would have been nonsignificant. Based on independent calculations from the data in the article, it appears that a 1-tailed Fisher exact test was . . . [Full Text of this Article]

Joel B. Gunter, MD
joel.gunter@cchmc.org
Department of Anesthesia

J. Paul Willging, MD; Charles M. Myer III, MD
Department of Otolaryngology Head and Neck Surgery
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio

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Dexamethasone and Risk of Nausea and Vomiting and Postoperative Bleeding After Tonsillectomy in Children: A Randomized Trial
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Dexamethasone and Postoperative Bleeding After Tonsillectomy in Children—Reply
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JAMA. 2009;301(17):1765-1766.
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