PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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EVIDENCE-BASED SEARCH
Specific
treatments for children with Herpes simplex encephalitis
Background
Children who have an altered conscious level may have
herpes simplex encephalitits. The treatment of herpes
simplex encephalitis (HSE) with antiviral medication may improve outcome in children.
Is there evidence that treatment of suspected cases of HSE improves mortality
and neurological morbidity in children?
Objectives
To determine the treatments of children with herpes
simplex encephalitits which improve the mortality and
neurological morbidity.
Paper selection criteria
Inclusion criteria were drawn up before the search took
place. Papers were selected if they were randomised controlled trials of
antiviral treatments for Herpes simplex encephalitis, with concealment of
randomisation and if outcome measures included mortality and neurological
morbidity. Papers which studied adults and children would be included, as the
treatment effects would be likely to cross the age range. Papers in foreign
language journals would be included in the search and referenced but not
included in the final selection of papers due to limited translation
facilities.
Search strategy
A review of the Cochrane
library, MEDLINE (1966-present), EMBASE (1980-present), CINAHL (1982-present),
British Nusing Index (1985-present) and AMED
(1985-present) was performed in April 2004. The search terms can be reviewed
below. A review of the references of the selected papers for further evidence
was included in the search strategy. Authors of included papers were contacted
to clarify any uncertainties in the research methodology.
# |
Search History |
Results |
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1 |
RANDOMIZED CONTROLLED TRIAL.pt. |
188702 |
||
2 |
CONTROLLED CLINICAL TRIAL.pt. |
66249 |
||
|
randomized controlled trials.sh. |
33319 |
||
4 |
random allocation.sh. |
50966 |
||
5 |
double blind method.sh. |
78357 |
||
6 |
single blind method.sh. |
8068 |
||
7 |
or/1-6 |
320919 |
||
8 |
Animal.sh. |
17117 |
||
9 |
human.sh. |
13020367 |
||
10 |
8 not 9 |
14179 |
||
11 |
7 not 10 |
320918 |
||
12 |
clinical trial.pt. |
392544 |
||
13 |
exp clinical trials/ |
493355 |
||
14 |
(clin$
adj25 trial$).ti,ab. |
201983 |
||
15 |
((singl$
or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab. |
154873 |
||
16 |
placebos.sh. |
25805 |
||
17 |
placebo$.ti,ab. |
170336 |
||
18 |
random$.ti,ab. |
565198 |
||
19 |
research design.sh. |
39333 |
||
20 |
or/12-19 |
1277257 |
||
21 |
20 not 10 |
1277083 |
||
22 |
21 not 11 |
974908 |
||
23 |
comparative study.sh. |
1171853 |
||
24 |
exp evaluation studies/ |
517733 |
||
25 |
follow up studies.sh. |
283694 |
||
26 |
prospective studies.sh. |
204144 |
||
27 |
(control$ or prospectiv$ or volunteer$).ti,ab. |
2743177 |
||
28 |
or/23-27 |
4266411 |
||
29 |
28 not 10 |
4264936 |
||
30 |
29 not (11 or 22) |
3563933 |
||
31 |
11 or 22 or 28 |
4861234 |
||
32 |
exp infant, newborn/ or
exp infant/ or exp infants/ |
923566 |
||
33 |
exp adolescent/ or exp
adolescence/ or exp adolescent, hospitalized/ |
1388009 |
||
34 |
exp child/ or exp
children/ or exp child, preschool/ or exp childhood/ or exp child,
hospitalized/ |
1585340 |
||
35 |
32 or 33 or 34 |
2739385 |
||
36 |
35 and 31 |
711510 |
||
37 |
aciclovir.mp. [mp=ab, hw, ti, sh, it, tn,
ot, dm, mf, rw] |
15525 |
||
38 |
acyclovir.mp. [mp=ab, hw, ti, sh, it, tn,
ot, dm, mf, rw] |
11455 |
||
39 |
37 or 38 |
22407 |
||
40 |
39 and 36 |
1039 |
||
41 |
encephalitis.mp. [mp=ab, hw, ti, sh, it, tn,
ot, dm, mf, rw] |
31656 |
||
42 |
exp encephalitis/ |
44202 |
||
43 |
41 or 42 |
53293 |
||
44 |
40 and 43 |
105 |
||
45 |
vidarabine.mp. [mp=ab, hw, ti, sh, it, tn,
ot, dm, mf, rw] |
5740 |
||
46 |
45 and 36 |
219 |
||
47 |
46 and 43 |
39 |
|
Search results
From 144 titles, a total of
17 abstracts were reviewed.
From a hand search of the
references a further 5 abstracts were reviewed.
3 papers were selected for
review from the abstracts. [1-3]
Skoldenberg et al and Whitley et al (1977) were included.
Whitley et al 1986 was excluded as concealment of randomisation could not be
guaranteed.
1. Whitley, R., et al., Adenine arabinoside therapy of biopsy-proved Herpes simplex encephalitis. New England Journal of Medicine, 1977. 297(6): p. 289-294.
2. Skoldenberg, B., et al., Acyclovir verses vidarabine in Herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet, 1984. 2(8405): p. 707-711.
3. Whitley, R., et al., Vidarabine verses acyclovir therapy in Herpes simplex encephalitis. New England Journal of Medicine, 1986. 314: p. 144-9.