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.

 

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Search History

Results

1

RANDOMIZED CONTROLLED TRIAL.pt.

188702

2

CONTROLLED CLINICAL TRIAL.pt.

66249

3

 

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.