Logo
BROWSE EVIDENCE REPOSITORY

 

Acute Otitis Media English (1) French All (1)

Evidence Summary: Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge?

Visit

Venekamp RP, Prasad V, Hay AD

This summary presents results of a systematic review that searched to identify any published studies comparing the effectiveness of topical antibiotics with oral antibiotics, placebo, or no treatment in children with acute otitis media presenting with ear discharge caused by spontaneous perforation of the eardrum.

Evidence Summary: Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge?

Visit

Venekamp RP, Prasad V, Hay AD

This summary presents results of a systematic review that searched to identify any published studies comparing the effectiveness of topical antibiotics with oral antibiotics, placebo, or no treatment in children with acute otitis media presenting with ear discharge caused by spontaneous perforation of the eardrum.

Asthma English (7) French All (7)

Cochrane Summary: Holding chambers (spacers) versus nebulisers for delivery of beta-agonist relievers in the treatment of an asthma attack (2013)

Visit

Cates, CJ, Welsh, EJ, Rowe, BH,

Review question: When someone is having an asthma attack is it as safe and effective to use a spacer instead of a nebuliser? Background: During an asthma attack, the airways (tubes in the lungs) narrow making breathing difficult. The initial response to an asthma attack is to treat with a drug that can open up the airways and make breathing easier. These drugs are called bronchodilators and in this review we are looking specifically at a class of bronchodilators called beta-agonists (for example salbutamol). These drugs can be taken straight from an inhaler, but during an asthma attack they are easier to take using either a spacer or a nebuliser. A spacer is a hollow chamber. A puff of drug from an inhaler is added to the chamber and then the person breathes in and out normally (also described as tidal breathing), from a mouthpiece on the chamber. A nebuliser is a machine with a mask that goes over the person's mouth and nose and through which a constant stream of drug and air (or oxygen) is breathed in and out normally. What evidence did we find? We found 39 clinical trials involving 1897 children and 729 adults. Thirty-three of the trials were conducted in an emergency room (or emergency department) and community settings (such as a GP's surgery), and six trials were on inpatients (people in hospital) with acute asthma (207 children and 28 adults). Overall we judged the quality of the evidence to be moderate. What do the studies tell us? Taking beta-agonists through either a spacer or a nebuliser in the emergency department did not make a difference to the number of adults being admitted to hospital, whilst in children we can be fairly confident that nebulisers are not better than spacers at preventing admissions. In children, the length of stay in the emergency department was significantly shorter when the spacer was used instead of a nebuliser. The average stay in the emergency department for children given nebulised treatment was 103 minutes. Children given treatment via spacers spent an average of 33 minutes less. In adults, the length of stay in the emergency department was similar for the two delivery methods. However the adult studies were conducted slightly differently which may have made it more difficult to show a difference in the length of stay in the emergency department. Because all the adult studies used a so-called "double-dummy" design, the adults received a spacer AND a nebuliser (either beta-agonist in a spacer and a dummy nebuliser or vice versa) which meant both groups of people were in the emergency department for as long as it took to take both treatments. Lung function tests were also similar for the two delivery methods in both adults and children. Pulse rate was lower in children taking beta-agonists through a spacer (mean difference 5% baseline), and there was a lower risk of developing tremor. Conclusion: Metered-dose inhalers with a spacer can perform at least as well as wet nebulisation in delivering beta-agonists in children with acute asthma, but we are less certain about the results in adults.

Cochrane Summary: Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children (2013)

Visit

Griffiths, B, Ducharme, FM,

Background: In an asthma attack, the airways (small tubes in the lungs) narrow because of inflammation (swelling), muscle spasms and mucus secretions. Other symptoms include wheezing, coughing and chest tightness. This makes breathing difficult. Reliever inhalers typically contain short-acting beta2-agonists (SABAs) that relax the muscles in the airways, opening the airways so that breathing is easier. Anticholinergic drugs work by opening the airways and decreasing mucus secretions. Review question: We looked at randomised controlled trials to find out whether giving inhaled anticholinergics plus SABAs (instead of SABAs on their own) in the emergency department provides benefits or harms in children having an asthma attack. Key results: We found that children with a moderate or severe asthma attack who were given both drugs in the emergency department were less likely to be admitted to the hospital than those who only had SABAs. In the group receiving only SABAs, on average 23 out of 100 children with acute asthma were admitted to hospital compared with an average of 17 (95% CI 15 to 20) out of 100 children treated with SABAs plus anticholinergics. Taking both drugs was also better at improving lung function. Taking both drugs did not seem to reduce the possibility of another asthma attack. Fewer children treated with anticholinergics reported nausea and tremor, but no significant group difference was observed for vomiting. Quality of the evidence and further research: Most of the studies were in preschool- and school-aged children; three studies also included a small proportion of infants under 18 months of age, although there was no evidence that inclusion of these infants with wheezy episodes affected the results. Nine trials (45%) were at a low risk of bias and we regarded the evidence for hospitalisation as high quality. Physicians can administer the dose of anticholinergic and SABA in several different ways; as a single dose, or as a certain number of doses or more flexibly. Most of the trials gave the children two or three doses and we think that more research is needed to improve characterization of children that benefit from, and the most effective number and frequency of doses of, anticholinergic treatment.

Cochrane Summary: Inhaled corticosteroids for acute asthma following emergency department discharge (2012)

Visit

Edmonds, ML, Milan, SJ, Brenner, BE, Camargo, CA, Rowe, BH,

Acuteasthma is a common cause of visits toemergencydepartments (ED) and the majority of patients are treated and discharged home. Some people will have arelapseofacuteasthma within two weeks of being discharged after apparently successful treatment. Beta2-agonist drugs are used to open the muscles in the airways and corticosteroids drugs are used to reduce inflammation of the swollen airways.Corticosteroidscan be inhaled (ICS) or swallowed as a tablet (so-calledoralcorticosteroids). ICS may reduceadverse effectsand get to the airways more directly thanoralcorticosteroids. Thisreviewof trials found that there was insufficient evidence that inhaling corticosteroids as well as taking the drugs orally is better thanoraluse alone, afteremergencydepartment treatment for an asthma attack. There is also insufficient evidence that taking ICS alone is as good as taking them orally, although there is some evidence to support using ICS alone for mild asthma attacks afteremergencydepartment discharge. Moreresearchis needed.

Cochrane Summary: Role of ketamine for management of acute severe asthma in children (2012)

Visit

Jat, KR, Chawla, D,

Children frequently visit theemergencydepartment foracuteexacerbation of asthma. Some of these children fail to respond tostandard treatment(corticosteroids and bronchodilators) with increasedmorbidity. Ketamine has bronchodilatory properties and may be useful foracuteexacerbation of asthma. We evaluated theefficacyof ketamine for management of severeacuteasthma in children who had not responded to standardtherapy. We found, through systematic search, only onestudywhere investigators assessed the usefulness of ketamine for management of severeacuteasthma in children. While this singlestudysuggested that there is a lack of evidence for usefulness of ketamine inacuteexacerbation of asthma in children, more trials are needed regarding the use of ketamine inacuteasthma before more specific recommendations can be made.

Cochrane Summary: What are the effects of educational interventions delivered to children and/or their families, who have experienced an emergency department visit with their asthma within the previous 12 months? (2010)

Visit

Boyd, M, Lasserson, TJ, McKean, MC, Gibson, PG, Ducharme, FM, Haby, M,

Asthma care for children in our society is common and costly. There is now evidence that educationalinterventionfor children who have attended theemergencydepartment for asthma lowers theriskof the need for futureemergencydepartment visits and hospital admissions. Thisreviewlooked at studies which compared usual care for asthma to more intensive educational programmes and the results showed astatistically significantreduction in the treatment groups needing subsequentemergencydepartment visits or hospital admissions. We were not able to determine the most effective type, duration or intensity ofeducationthat should be offered to children to offer the best asthma outcomes.

Cochrane Summary: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department (2009)

Visit

Rowe, BH, Bretzlaff, J, Bourdon, C, Bota, G, Blitz, S, Camargo, CA,

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilator drugs (reliever inhalers) can be used to relax the muscles and open the airways, and corticosteroid drugs to reduce the inflammation. Magnesium sulfate is a drug that can also affect muscles, and may reduce inflammation as well. It can be given through a drip in the veins (intravenously). Thereviewof trials found thatintravenousmagnesium sulfate in addition to bronchodilators seems to be safe and beneficial for people with severe asthma attacks, or those for whom bronchodilators are not working.

Cochrane Summary: Early emergency department treatment of acute asthma with systemic corticosteroids (2008)

Visit

Rowe, BH, Spooner, C, Ducharme, F, Bretzlaff, J, Bota, G,

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilators (reliever inhalers to open up the lungs and airways) can be used for the spasms, and corticosteroids for the swelling.Corticosteroidscan be inhaled, or taken by mouth (orally) or through a drip into the veins (intravenously). Thereviewof trials found thatsystemic(oralorintravenous) corticosteroids reduce the need for people with asthma attacks to stay in hospital, with fewadverse effects.

Cochrane Summary: Holding chambers (spacers) versus nebulisers for delivery of beta-agonist relievers in the treatment of an asthma attack (2013)

Visit

Cates, CJ, Welsh, EJ, Rowe, BH,

Review question: When someone is having an asthma attack is it as safe and effective to use a spacer instead of a nebuliser? Background: During an asthma attack, the airways (tubes in the lungs) narrow making breathing difficult. The initial response to an asthma attack is to treat with a drug that can open up the airways and make breathing easier. These drugs are called bronchodilators and in this review we are looking specifically at a class of bronchodilators called beta-agonists (for example salbutamol). These drugs can be taken straight from an inhaler, but during an asthma attack they are easier to take using either a spacer or a nebuliser. A spacer is a hollow chamber. A puff of drug from an inhaler is added to the chamber and then the person breathes in and out normally (also described as tidal breathing), from a mouthpiece on the chamber. A nebuliser is a machine with a mask that goes over the person's mouth and nose and through which a constant stream of drug and air (or oxygen) is breathed in and out normally. What evidence did we find? We found 39 clinical trials involving 1897 children and 729 adults. Thirty-three of the trials were conducted in an emergency room (or emergency department) and community settings (such as a GP's surgery), and six trials were on inpatients (people in hospital) with acute asthma (207 children and 28 adults). Overall we judged the quality of the evidence to be moderate. What do the studies tell us? Taking beta-agonists through either a spacer or a nebuliser in the emergency department did not make a difference to the number of adults being admitted to hospital, whilst in children we can be fairly confident that nebulisers are not better than spacers at preventing admissions. In children, the length of stay in the emergency department was significantly shorter when the spacer was used instead of a nebuliser. The average stay in the emergency department for children given nebulised treatment was 103 minutes. Children given treatment via spacers spent an average of 33 minutes less. In adults, the length of stay in the emergency department was similar for the two delivery methods. However the adult studies were conducted slightly differently which may have made it more difficult to show a difference in the length of stay in the emergency department. Because all the adult studies used a so-called "double-dummy" design, the adults received a spacer AND a nebuliser (either beta-agonist in a spacer and a dummy nebuliser or vice versa) which meant both groups of people were in the emergency department for as long as it took to take both treatments. Lung function tests were also similar for the two delivery methods in both adults and children. Pulse rate was lower in children taking beta-agonists through a spacer (mean difference 5% baseline), and there was a lower risk of developing tremor. Conclusion: Metered-dose inhalers with a spacer can perform at least as well as wet nebulisation in delivering beta-agonists in children with acute asthma, but we are less certain about the results in adults.

Cochrane Summary: Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children (2013)

Visit

Griffiths, B, Ducharme, FM,

Background: In an asthma attack, the airways (small tubes in the lungs) narrow because of inflammation (swelling), muscle spasms and mucus secretions. Other symptoms include wheezing, coughing and chest tightness. This makes breathing difficult. Reliever inhalers typically contain short-acting beta2-agonists (SABAs) that relax the muscles in the airways, opening the airways so that breathing is easier. Anticholinergic drugs work by opening the airways and decreasing mucus secretions. Review question: We looked at randomised controlled trials to find out whether giving inhaled anticholinergics plus SABAs (instead of SABAs on their own) in the emergency department provides benefits or harms in children having an asthma attack. Key results: We found that children with a moderate or severe asthma attack who were given both drugs in the emergency department were less likely to be admitted to the hospital than those who only had SABAs. In the group receiving only SABAs, on average 23 out of 100 children with acute asthma were admitted to hospital compared with an average of 17 (95% CI 15 to 20) out of 100 children treated with SABAs plus anticholinergics. Taking both drugs was also better at improving lung function. Taking both drugs did not seem to reduce the possibility of another asthma attack. Fewer children treated with anticholinergics reported nausea and tremor, but no significant group difference was observed for vomiting. Quality of the evidence and further research: Most of the studies were in preschool- and school-aged children; three studies also included a small proportion of infants under 18 months of age, although there was no evidence that inclusion of these infants with wheezy episodes affected the results. Nine trials (45%) were at a low risk of bias and we regarded the evidence for hospitalisation as high quality. Physicians can administer the dose of anticholinergic and SABA in several different ways; as a single dose, or as a certain number of doses or more flexibly. Most of the trials gave the children two or three doses and we think that more research is needed to improve characterization of children that benefit from, and the most effective number and frequency of doses of, anticholinergic treatment.

Cochrane Summary: Inhaled corticosteroids for acute asthma following emergency department discharge (2012)

Visit

Edmonds, ML, Milan, SJ, Brenner, BE, Camargo, CA, Rowe, BH,

Acuteasthma is a common cause of visits toemergencydepartments (ED) and the majority of patients are treated and discharged home. Some people will have arelapseofacuteasthma within two weeks of being discharged after apparently successful treatment. Beta2-agonist drugs are used to open the muscles in the airways and corticosteroids drugs are used to reduce inflammation of the swollen airways.Corticosteroidscan be inhaled (ICS) or swallowed as a tablet (so-calledoralcorticosteroids). ICS may reduceadverse effectsand get to the airways more directly thanoralcorticosteroids. Thisreviewof trials found that there was insufficient evidence that inhaling corticosteroids as well as taking the drugs orally is better thanoraluse alone, afteremergencydepartment treatment for an asthma attack. There is also insufficient evidence that taking ICS alone is as good as taking them orally, although there is some evidence to support using ICS alone for mild asthma attacks afteremergencydepartment discharge. Moreresearchis needed.

Cochrane Summary: Role of ketamine for management of acute severe asthma in children (2012)

Visit

Jat, KR, Chawla, D,

Children frequently visit theemergencydepartment foracuteexacerbation of asthma. Some of these children fail to respond tostandard treatment(corticosteroids and bronchodilators) with increasedmorbidity. Ketamine has bronchodilatory properties and may be useful foracuteexacerbation of asthma. We evaluated theefficacyof ketamine for management of severeacuteasthma in children who had not responded to standardtherapy. We found, through systematic search, only onestudywhere investigators assessed the usefulness of ketamine for management of severeacuteasthma in children. While this singlestudysuggested that there is a lack of evidence for usefulness of ketamine inacuteexacerbation of asthma in children, more trials are needed regarding the use of ketamine inacuteasthma before more specific recommendations can be made.

Cochrane Summary: What are the effects of educational interventions delivered to children and/or their families, who have experienced an emergency department visit with their asthma within the previous 12 months? (2010)

Visit

Boyd, M, Lasserson, TJ, McKean, MC, Gibson, PG, Ducharme, FM, Haby, M,

Asthma care for children in our society is common and costly. There is now evidence that educationalinterventionfor children who have attended theemergencydepartment for asthma lowers theriskof the need for futureemergencydepartment visits and hospital admissions. Thisreviewlooked at studies which compared usual care for asthma to more intensive educational programmes and the results showed astatistically significantreduction in the treatment groups needing subsequentemergencydepartment visits or hospital admissions. We were not able to determine the most effective type, duration or intensity ofeducationthat should be offered to children to offer the best asthma outcomes.

Cochrane Summary: Magnesium sulfate for treating exacerbations of acute asthma in the emergency department (2009)

Visit

Rowe, BH, Bretzlaff, J, Bourdon, C, Bota, G, Blitz, S, Camargo, CA,

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilator drugs (reliever inhalers) can be used to relax the muscles and open the airways, and corticosteroid drugs to reduce the inflammation. Magnesium sulfate is a drug that can also affect muscles, and may reduce inflammation as well. It can be given through a drip in the veins (intravenously). Thereviewof trials found thatintravenousmagnesium sulfate in addition to bronchodilators seems to be safe and beneficial for people with severe asthma attacks, or those for whom bronchodilators are not working.

Cochrane Summary: Early emergency department treatment of acute asthma with systemic corticosteroids (2008)

Visit

Rowe, BH, Spooner, C, Ducharme, F, Bretzlaff, J, Bota, G,

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilators (reliever inhalers to open up the lungs and airways) can be used for the spasms, and corticosteroids for the swelling.Corticosteroidscan be inhaled, or taken by mouth (orally) or through a drip into the veins (intravenously). Thereviewof trials found thatsystemic(oralorintravenous) corticosteroids reduce the need for people with asthma attacks to stay in hospital, with fewadverse effects.

Bacterial Meningitis English (4) French All (4)

Cochrane Summary: Fluids for people with acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Summary: Corticosteroids for bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Summary: Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

Visit

Ostermayer DG, Koyfman A

Objective: To determine if a clinical prediction rule can reliably determine which children should be hospitalized and treated with intravenous antibiotics for bacterial meningitis.

Summary: In children with bacterial meningitis, does the addition of dexamethasone to an antibiotic treatment regimen result in a better clinical outcome than the antibiotic regimen alone?: Part A: Evidence-based answer and summary

Visit

Fox JL

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

Cochrane Summary: Fluids for people with acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Summary: Corticosteroids for bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Summary: Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

Visit

Ostermayer DG, Koyfman A

Objective: To determine if a clinical prediction rule can reliably determine which children should be hospitalized and treated with intravenous antibiotics for bacterial meningitis.

Summary: In children with bacterial meningitis, does the addition of dexamethasone to an antibiotic treatment regimen result in a better clinical outcome than the antibiotic regimen alone?: Part A: Evidence-based answer and summary

Visit

Fox JL

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

Bronchiolitis English (8) French All (8)

Overview of Systematic Reviews: Evidence Summary: Bronchiolitis

Download

Alberta Research Centre for Health Evidence (ARCHE)

Evidence summary for the treatment and management of bronchiolitis.

Cochrane Summary: Antibiotics for bronchiolitis in children under two years of age

Visit

Farley R, Spurling GK, Eriksson L, Del Mar CB

This review summarizes evidence on the effect of antibiotics on clinical outcomes in children with bronchiolitis.

Cochrane Summary: Bronchodilators for bronchiolitis for infants with first-time wheezing

Visit

Gadomski AM, Scribani MB

This review summarizes the evidence about the effect of bronchodilators in infants with bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: An overview of reviews

Visit

Fernandes RM, Oleszczuk M, Woods CR, Rowe BH, Cates CJ, Hartling L.

Objective: To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (<2 weeks) corticosteroid use based on systematic reviews of acute respiratory conditions.

Cochrane Summary: Hypertonic saline solution administered via nebuliser for acute bronchiolitis in infants

Visit

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Cochrane Summary: Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

Visit

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and the treatment of bronchiolitis in children: An overview of reviews

Visit

Bialy L, Foisy M, Smith M, Fernandes RM

This updated overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the effectiveness and safety of 11 pharmacologic and non-pharmacologic treatments to improve bronchiolitis symptoms in outpatient, inpatient and intensive care populations.

Cochrane Summary: Epinephrine for acute viral bronchiolitis in children less than two years of age

Visit

Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Overview of Systematic Reviews: Evidence Summary: Bronchiolitis

Download

Alberta Research Centre for Health Evidence (ARCHE)

Evidence summary for the treatment and management of bronchiolitis.

Cochrane Summary: Antibiotics for bronchiolitis in children under two years of age

Visit

Farley R, Spurling GK, Eriksson L, Del Mar CB

This review summarizes evidence on the effect of antibiotics on clinical outcomes in children with bronchiolitis.

Cochrane Summary: Bronchodilators for bronchiolitis for infants with first-time wheezing

Visit

Gadomski AM, Scribani MB

This review summarizes the evidence about the effect of bronchodilators in infants with bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: An overview of reviews

Visit

Fernandes RM, Oleszczuk M, Woods CR, Rowe BH, Cates CJ, Hartling L.

Objective: To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (<2 weeks) corticosteroid use based on systematic reviews of acute respiratory conditions.

Cochrane Summary: Hypertonic saline solution administered via nebuliser for acute bronchiolitis in infants

Visit

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Cochrane Summary: Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

Visit

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and the treatment of bronchiolitis in children: An overview of reviews

Visit

Bialy L, Foisy M, Smith M, Fernandes RM

This updated overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the effectiveness and safety of 11 pharmacologic and non-pharmacologic treatments to improve bronchiolitis symptoms in outpatient, inpatient and intensive care populations.

Cochrane Summary: Epinephrine for acute viral bronchiolitis in children less than two years of age

Visit

Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Burns English (3) French All (3)

Cochrane Summary: Antiseptics for Burns

Visit

Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mo...

Objective: To assess the effects and safety of antiseptics for the treatment of burns in any care setting.

Cochrane Summary: Antibiotics to prevent burn wounds becoming infected

Visit

Barajas-Nava LA, Lpez-Alcalde J, Roqu i Figuls M, Sol I, Bonfill Cosp X

Objective: To assess the effects of antibiotic prophylaxis on rates of burn wound infection.

Cochrane Summary: Dressings for treating superficial and partial-thickness burns

Visit

Wasiak J, Cleland H, Campbell F, Spinks A

Objective: To assess the effects of burn wound dressings on superficial and partial thickness burns.

Cochrane Summary: Antiseptics for Burns

Visit

Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mo...

Objective: To assess the effects and safety of antiseptics for the treatment of burns in any care setting.

Cochrane Summary: Antibiotics to prevent burn wounds becoming infected

Visit

Barajas-Nava LA, Lpez-Alcalde J, Roqu i Figuls M, Sol I, Bonfill Cosp X

Objective: To assess the effects of antibiotic prophylaxis on rates of burn wound infection.

Cochrane Summary: Dressings for treating superficial and partial-thickness burns

Visit

Wasiak J, Cleland H, Campbell F, Spinks A

Objective: To assess the effects of burn wound dressings on superficial and partial thickness burns.

Concussion English (1) French All (1)

Evidence Summary: Management of paediatric minor head injuries. Safe discharge?

Visit

Hunter F

This summary answers the question: In paediatric patients with minor head injury, GCS (Glasgow Coma Score) 15 and no focal neurological deficit does a normal computed tomography brain scan allow safe discharge?

Evidence Summary: Management of paediatric minor head injuries. Safe discharge?

Visit

Hunter F

This summary answers the question: In paediatric patients with minor head injury, GCS (Glasgow Coma Score) 15 and no focal neurological deficit does a normal computed tomography brain scan allow safe discharge?

Constipation English (2) French All (2)

Cochrane Summary: Laxatives for the management of childhood constipation

Visit

Gordon M, MacDonald JK, Parker CE, Akobeng AK, Thomas AG

This summary addresses the questions: What are the effectiveness and side effects of osmotic and stimulant laxatives used for the treatment of functional childhood constipation?

Guideline Summary: Idiopathic constipation in children clinical practice guidelines

Visit

Paul SP, Broad SR, Spray C

This is a review of current guidelines for diagnosing and managing idiopathic constipation in children.

Cochrane Summary: Laxatives for the management of childhood constipation

Visit

Gordon M, MacDonald JK, Parker CE, Akobeng AK, Thomas AG

This summary addresses the questions: What are the effectiveness and side effects of osmotic and stimulant laxatives used for the treatment of functional childhood constipation?

Guideline Summary: Idiopathic constipation in children clinical practice guidelines

Visit

Paul SP, Broad SR, Spray C

This is a review of current guidelines for diagnosing and managing idiopathic constipation in children.

Croup English (6) French All (6)

Cochrane Summary: Glucocorticoids for croup in children

Visit

Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,

Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.

Cochrane Summary: Helium-oxygen (heliox) treatment for children with croup

Visit

Moraa I, Sturman N, McGuire TM, van Driel ML,

Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.

Summary: Evidence for Clinicians: Nebulized epinephrine for croup in children

Visit

Kawaguchi A, Joffe A,

Expert commentary on the Cochrane Review on nebulized epinephrine for reducing symptoms in children with severe croup. 

Cochrane Overview: Evidence Summary: Croup

Download

Alberta Research Centre for Health Evidence (ARCHE),

The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews.

Cochrane Summary: Nebulized epinephrine for croup in children

Visit

Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Cochrane Overview: The Cochrane Library and the treatment of croup in children: an overview of reviews

Visit

Bjornson, C, Russell, K, Foisy, M, Johnson, D,

Objective: To synthesize the evidence currently in the Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup - glucocorticoids, epinephrine, heliox and humidified air.

Cochrane Summary: Glucocorticoids for croup in children

Visit

Gates A, Gates M, Vandermeer B, Johnson C, Hartling L, Johnson DW, Klassen TP,

Objective: To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.

Cochrane Summary: Helium-oxygen (heliox) treatment for children with croup

Visit

Moraa I, Sturman N, McGuire TM, van Driel ML,

Objective: To examine the effect of heliox compared to oxygen or other active interventions, placebo, or no treatment, on relieving signs and symptoms in children with croup as determined by a croup score and rates of admission and intubation.

Summary: Evidence for Clinicians: Nebulized epinephrine for croup in children

Visit

Kawaguchi A, Joffe A,

Expert commentary on the Cochrane Review on nebulized epinephrine for reducing symptoms in children with severe croup. 

Cochrane Overview: Evidence Summary: Croup

Download

Alberta Research Centre for Health Evidence (ARCHE),

The purpose of this document is to describe the effectiveness of four treatment options, based on a 2012 Overview of Reviews.

Cochrane Summary: Nebulized epinephrine for croup in children

Visit

Bjornson, C, Russell, K, Vandermeer, B, Klassen, TP, Johnson, DW,

Objective: To assess the efficacy (measured by croup scores, rate of intubation and health care utilization such as rate of hospitalization) and safety (frequency and severity of side effects) of nebulized epinephrine versus placebo in children with croup, evaluated in an emergency department (ED) or hospital setting.

Cochrane Overview: The Cochrane Library and the treatment of croup in children: an overview of reviews

Visit

Bjornson, C, Russell, K, Foisy, M, Johnson, D,

Objective: To synthesize the evidence currently in the Cochrane Database of Systematic Reviews (CDSR) related to the clinical effectiveness and applicability of four treatments for croup - glucocorticoids, epinephrine, heliox and humidified air.

Febrile Status Epilepticus English (2) French All (2)

BMJ Clinical Review: Febrile seizures

Visit

Patel N, Ram D, Swiderska N, Mewasingh LD, Newton RW, Offringa M

This review aims to summarise how to recognise a febrile seizure and rule out other underlying causes, how to manage febrile seizures and how to deal with common questions posed by parents in this situation.

Review: Evaluation and Management of Pediatric Febrile Seizures in the Emergency Department

Visit

Hampers LC, Spina LA

This review describes the differences between simple and complex febrile seizures in pediatric patients. The document provides an overview of clinical assessment, laboratory testing, imaging and discharge instructions.

BMJ Clinical Review: Febrile seizures

Visit

Patel N, Ram D, Swiderska N, Mewasingh LD, Newton RW, Offringa M

This review aims to summarise how to recognise a febrile seizure and rule out other underlying causes, how to manage febrile seizures and how to deal with common questions posed by parents in this situation.

Review: Evaluation and Management of Pediatric Febrile Seizures in the Emergency Department

Visit

Hampers LC, Spina LA

This review describes the differences between simple and complex febrile seizures in pediatric patients. The document provides an overview of clinical assessment, laboratory testing, imaging and discharge instructions.

Fractures English (1) French All (1)

Cochrane Summary: Antibiotics for preventing infection in open limb fractures

Visit

Gosselin, RA, Roberts, I & Gillespie, WJ

Objective: To review the evidence for the effectiveness of antibiotics in the initial treatment of open fractures of the limbs.

Cochrane Summary: Antibiotics for preventing infection in open limb fractures

Visit

Gosselin, RA, Roberts, I & Gillespie, WJ

Objective: To review the evidence for the effectiveness of antibiotics in the initial treatment of open fractures of the limbs.

Gastroenteritis English (5) French All (5)

Cochrane Summary: The use of probiotics to prevent Clostridium difficile diarrhea associated with antibiotic use

Visit

Goldenberg JZ, Yap C, Lytvyn L, Lo CK, Beardsley J, Mertz D, Johnston BC

Summarizes research to determine if probiotics prevent Clostridium difficile-associated diarrhea in adults and children receiving antibiotic therapy, and whether probiotics cause any harms.

Evidence Summary: Gastroenteritis

Download

Alberta Research Centre for Health Evidence (ARCHE)

The purpose of this document is to describe the effectiveness of three treatment options for pediatric gastroenteritis, based on a 2013 overview of reviews by Freedman SB et al.

Cochrane Overview: Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries

Visit

Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L

The purpose of this overview is to critically evaluate the evidence currently available in the Cochrane Database of Systematic Reviews regarding the efficacy and safety of commonly considered treatment options in children with acute gastroenteritis.

Cochrane Summary: Anti-sickness medication for vomiting in acute stomach upsets in children

Visit

Fedorowicz Z, Jagannath VA, Carter B

Vomiting caused byacutegastroenteritis is very common in children and adolescents. Treatment of vomiting in children withacutegastroenteritis can be problematic and there is lack of agreement among clinicians on the indications for the use of antiemetics. There have also been concerns expressed about apparently unacceptable levels of side effects with some of the older generation of antiemetics. The small number of included trials provided evidence which appeared to favour the use of antiemetics overplaceboto reduce the number of episodes of vomiting due to gastroenteritis in children. A singleoraldose of ondansetron given to children with mild to moderate dehydration cancontrolvomiting, avoid hospitalization andintravenousfluid administration which would otherwise be needed. There were no major side effects other than a few reports of increased frequency of diarrhea.

Cochrane Summary: Children with dehydration due to gastroenteritis need to be rehydrated, and this review did not show any important differences between giving fluids orally or intravenously

Visit

Hartling L, Bellemare S, Wiebe N, Russell KF, Klassen TP, Craig WR

Dehydration is when body water content is reduced causing dry skin, headaches, sunken eyes, dizziness, confusion, and sometimes death. Children with dehydration due to gastroenteritis need rehydrating either by liquids given by mouth or a tube through the nose, or intravenously. Thereviewof 17 trials (some funded by drug companies) found that the trials were not of high quality; however the evidence suggested that there are no clinically important differences between giving fluids orally or intravenously. For every 25 children treated with fluids given orally, one child would fail and requireintravenousrehydration. Further, the results for low osmolarity solutions, the currently recommended treatment by the World Health Organization, showed a lower failure rate fororalrehydration that was not significantly different from that ofintravenousrehydration. Oral rehydration should be the first line of treatment in children with mild to moderate dehydration withintravenoustherapybeing used if theoralroute fails. The evidence showed that there may be a higherriskof paralytic ileus withoralrehydration whileintravenoustherapycarries theriskofphlebitis(ie inflammation of the veins).

Cochrane Summary: The use of probiotics to prevent Clostridium difficile diarrhea associated with antibiotic use

Visit

Goldenberg JZ, Yap C, Lytvyn L, Lo CK, Beardsley J, Mertz D, Johnston BC

Summarizes research to determine if probiotics prevent Clostridium difficile-associated diarrhea in adults and children receiving antibiotic therapy, and whether probiotics cause any harms.

Evidence Summary: Gastroenteritis

Download

Alberta Research Centre for Health Evidence (ARCHE)

The purpose of this document is to describe the effectiveness of three treatment options for pediatric gastroenteritis, based on a 2013 overview of reviews by Freedman SB et al.

Cochrane Overview: Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries

Visit

Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L

The purpose of this overview is to critically evaluate the evidence currently available in the Cochrane Database of Systematic Reviews regarding the efficacy and safety of commonly considered treatment options in children with acute gastroenteritis.

Cochrane Summary: Anti-sickness medication for vomiting in acute stomach upsets in children

Visit

Fedorowicz Z, Jagannath VA, Carter B

Vomiting caused byacutegastroenteritis is very common in children and adolescents. Treatment of vomiting in children withacutegastroenteritis can be problematic and there is lack of agreement among clinicians on the indications for the use of antiemetics. There have also been concerns expressed about apparently unacceptable levels of side effects with some of the older generation of antiemetics. The small number of included trials provided evidence which appeared to favour the use of antiemetics overplaceboto reduce the number of episodes of vomiting due to gastroenteritis in children. A singleoraldose of ondansetron given to children with mild to moderate dehydration cancontrolvomiting, avoid hospitalization andintravenousfluid administration which would otherwise be needed. There were no major side effects other than a few reports of increased frequency of diarrhea.

Cochrane Summary: Children with dehydration due to gastroenteritis need to be rehydrated, and this review did not show any important differences between giving fluids orally or intravenously

Visit

Hartling L, Bellemare S, Wiebe N, Russell KF, Klassen TP, Craig WR

Dehydration is when body water content is reduced causing dry skin, headaches, sunken eyes, dizziness, confusion, and sometimes death. Children with dehydration due to gastroenteritis need rehydrating either by liquids given by mouth or a tube through the nose, or intravenously. Thereviewof 17 trials (some funded by drug companies) found that the trials were not of high quality; however the evidence suggested that there are no clinically important differences between giving fluids orally or intravenously. For every 25 children treated with fluids given orally, one child would fail and requireintravenousrehydration. Further, the results for low osmolarity solutions, the currently recommended treatment by the World Health Organization, showed a lower failure rate fororalrehydration that was not significantly different from that ofintravenousrehydration. Oral rehydration should be the first line of treatment in children with mild to moderate dehydration withintravenoustherapybeing used if theoralroute fails. The evidence showed that there may be a higherriskof paralytic ileus withoralrehydration whileintravenoustherapycarries theriskofphlebitis(ie inflammation of the veins).

Intussusception English (6) French All (6)

Cochrane Summary: Management of intussusception in children

Visit

Gluckman S, Karpelowsky J, Webster AC, McGee RG

Objective: To assess the safety and effectiveness of non-surgical and surgical approaches in the management of intussusception in children.

Cochrane Summary: Vaccines for preventing rotavirus diarrhoea: vaccines in use

Visit

Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, ...

Objective: To evaluate rotavirus vaccines approved for use (RV1, RV5, and LLR) for preventing rotavirus diarrhoea.

Evidence Summary: Towards evidence based medicine for paediatricians. Question 3. Does the administration of glucagon improve the rate of radiological reduction in children with acute intestinal intussusception?

Visit

Cachat F, Ramseyer P,

This summary examines the relationship between glucagon and the rate of radiological reduction for acute intestinal intussusception.

Evidence Summary: Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Can emergency physicians safely rule in or rule out paediatric intussusception in the emergency department using bedside ultrasound?

Visit

Raymond-Dufresne , Ghanayem H,

This summary investigates the diagnostic use of bedside ultrasound for paediatric intussusception in the emergency department.

Evidence Summary: Best evidence topic reports. Bet 4. Role of plain abdominal radiograph in the diagnosis of intussusception

Visit

Broomfield D, Maconochie I,

This summary investigates the role of plain abdominal radiograph in the diagnosis of intussusception

Evidence Summary: Clinically suspected intussusception in children: evidence based review and self-assessment module

Visit

Applegate KE,

This summary uses case examples to review the current evidence for the management of children with clinically suspected intussusception.

Cochrane Summary: Management of intussusception in children

Visit

Gluckman S, Karpelowsky J, Webster AC, McGee RG

Objective: To assess the safety and effectiveness of non-surgical and surgical approaches in the management of intussusception in children.

Cochrane Summary: Vaccines for preventing rotavirus diarrhoea: vaccines in use

Visit

Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, ...

Objective: To evaluate rotavirus vaccines approved for use (RV1, RV5, and LLR) for preventing rotavirus diarrhoea.

Evidence Summary: Towards evidence based medicine for paediatricians. Question 3. Does the administration of glucagon improve the rate of radiological reduction in children with acute intestinal intussusception?

Visit

Cachat F, Ramseyer P,

This summary examines the relationship between glucagon and the rate of radiological reduction for acute intestinal intussusception.

Evidence Summary: Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Can emergency physicians safely rule in or rule out paediatric intussusception in the emergency department using bedside ultrasound?

Visit

Raymond-Dufresne , Ghanayem H,

This summary investigates the diagnostic use of bedside ultrasound for paediatric intussusception in the emergency department.

Evidence Summary: Best evidence topic reports. Bet 4. Role of plain abdominal radiograph in the diagnosis of intussusception

Visit

Broomfield D, Maconochie I,

This summary investigates the role of plain abdominal radiograph in the diagnosis of intussusception

Evidence Summary: Clinically suspected intussusception in children: evidence based review and self-assessment module

Visit

Applegate KE,

This summary uses case examples to review the current evidence for the management of children with clinically suspected intussusception.

Lower Extremity Fractures English (1) French All (1)

Cochrane Summary: Different methods of treating fractures of the shaft of the thigh bone in children and adolescents

Visit

Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

Cochrane Summary: Different methods of treating fractures of the shaft of the thigh bone in children and adolescents

Visit

Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

Lyme Disease English (1) French All (1)

Cochrane Summary: Treatment for the neurological complications of Lyme disease

Visit

Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H

Objective: To assess the effects of antibiotics for the treatment of Lyme neuroborreliosis (LNB).

Cochrane Summary: Treatment for the neurological complications of Lyme disease

Visit

Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H

Objective: To assess the effects of antibiotics for the treatment of Lyme neuroborreliosis (LNB).

Meningitis English (5) French All (5)

Cochrane Summary: Fluids for people with acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Summary: Treatment for the neurological complications of Lyme disease

Visit

Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H

Objective: To assess the effects of antibiotics for the treatment of Lyme neuroborreliosis (LNB).

Cochrane Summary: Corticosteroids for bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Summary: Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

Visit

Ostermayer DG, Koyfman A

Objective: To determine if a clinical prediction rule can reliably determine which children should be hospitalized and treated with intravenous antibiotics for bacterial meningitis.

Summary: In children with bacterial meningitis, does the addition of dexamethasone to an antibiotic treatment regimen result in a better clinical outcome than the antibiotic regimen alone?: Part A: Evidence-based answer and summary

Visit

Fox JL

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

Cochrane Summary: Fluids for people with acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Summary: Treatment for the neurological complications of Lyme disease

Visit

Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H

Objective: To assess the effects of antibiotics for the treatment of Lyme neuroborreliosis (LNB).

Cochrane Summary: Corticosteroids for bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Summary: Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

Visit

Ostermayer DG, Koyfman A

Objective: To determine if a clinical prediction rule can reliably determine which children should be hospitalized and treated with intravenous antibiotics for bacterial meningitis.

Summary: In children with bacterial meningitis, does the addition of dexamethasone to an antibiotic treatment regimen result in a better clinical outcome than the antibiotic regimen alone?: Part A: Evidence-based answer and summary

Visit

Fox JL

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

Pain Treatment English (3) French All (3)

Cochrane Summary: Intranasal fentanyl for the treatment of children in acute pain

Visit

Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Background: Pain is the most common reason why patients are seen in emergency departments (EDs). The challenging nature of treating children in acute severe pain is reflected in the medical literature by poor pain management in this population. We reviewed evidence on the effect of intranasal fentanyl (INF) (a strong pain relief drug, similar to morphine) compared with any other pain-relieving technique for treatment of children in acute severe pain. Study characteristics: We included studies with children (younger than 18 years of age) suffering from acute severe pain as a result of injury or medical illness. The target intervention was INF administered for pain relief compared with any other drug intervention for pain relief (e.g. intravenous morphine) or non-drug intervention (e.g. limb splinting, wound dressing) provided in the emergency setting. The evidence is current to January 2014. Key results: We identified three studies that included 313 children with acute severe pain resulting from broken bones of the upper and lower limbs. These trials compared INF versus morphine administered by a needle into a muscle (intramuscular morphine) or via a drip into a vein (intravenous morphine), as well as standard concentration INF versus high concentration INF. The collective study population in these trials consisted of children three to 15 years of age. Males accounted for approximately two-thirds of the overall study population. The review concluded that INF may be an effective analgesic for the treatment of children in acute moderate to severe pain, and its administration appears to cause minimal distress to children; however, the evidence is insufficient to permit judgement of the effects of INF compared with intramuscular or intravenous morphine. No serious adverse events (e.g. opiate toxicity, death) were reported. Limitations: Limitations of this review include the following: Few studies (three) were eligible for inclusion; no study examined the use of INF in children younger than three years of age; no study included children with pain resulting from a "medical" cause (e.g. abdominal pain seen in appendicitis); and all eligible studies were conducted in Australia. Consequently, the findings may not be generalizable to other healthcare settings, to children younger than three years of age and to those with pain from a "medical" cause.

Cochrane Summary: Nerve blocks for initial pain management of thigh bone fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Fractures (breaks) of the thigh bone can be very painful, particularly when a child arrives in a stressful emergency environment and is undergoing assessment. Moving the child to get X-rays or transferring the child to a special bed to support the leg in traction (keeping the leg straight) can cause additional pain, as can placing traction (a pulling force) on the broken thigh. This means that prompt provision of pain relief is an essential part of initial emergency management. This review investigated whether a nerve block, involving the injection of a freezing/numbing medication at the top of the thigh, would provide more effective pain relief than pain medicine given by mouth or into a vein (intravenously, e.g. morphine). We searched several medical databases and trial registries up to January 2013 and contacted researchers. We found one study that looked at the comparison we were interested in. This study was potentially biased, mainly because the care providers, parents and children were aware of the type of pain relief the children received. The study was small, involving 55 children aged 16 months to 15 years, and showed that the children who received one of the two main types of nerve block tended to have less pain after 30 minutes than those who received intravenous morphine for initial pain control. The nerve blocks led to some pain and redness at the injection site in a few cases, while intravenous morphine caused more serious problems such as depressed breathing (lack of oxygen), excessive sleepiness and vomiting in a small number of children. Moreover, children who had nerve blocks continued to have lower pain scores over a six-hour period with less need for additional pain relief. There was insufficient evidence to determine whether children or parents were more satisfied with one method of pain relief than the other. Use of resources (e.g. nursing time, cost of medications) was not measured. The quality of the study included in this review was low and so these conclusions are not certain. Further well designed studies investigating whether nerve blocks are more effective and safer than other means of pain relief are needed.

Cochrane Summary: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Antibiotics make little difference to children with an uncomplicated ear infection and ear pain. Some advocate ear drops with local anaesthetic such as amethocaine, benzocaine or lidocaine. Five trials (391 participants) were identified; two compared anaesthetic drops to placebo (inactive) drops; and three compared anaesthetic drops to herbal ear drops. There was no strong evidence that herbal ear drops were effective, but anaesthetic drops did provide better pain relief than the inactive drops. Only one trial looked at adverse reactions and reported no cases of ringing in the ears or unsteadiness when walking and three cases of very mild dizziness. Children in all the trials experienced a rapid, short-term reduction in pain after using ear drops. It is hard to know if this was the result of the natural course of the illness; the placebo effect of receiving treatment; the soothing effect of any liquid in the ear or the pharmacological effects of the ear drops themselves. Nevertheless, there is some evidence that when combined with oral pain medication, anaesthetic ear drops may help to relieve pain more rapidly in children aged three to 18 years. More good-quality trials are needed.

Cochrane Summary: Intranasal fentanyl for the treatment of children in acute pain

Visit

Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Background: Pain is the most common reason why patients are seen in emergency departments (EDs). The challenging nature of treating children in acute severe pain is reflected in the medical literature by poor pain management in this population. We reviewed evidence on the effect of intranasal fentanyl (INF) (a strong pain relief drug, similar to morphine) compared with any other pain-relieving technique for treatment of children in acute severe pain. Study characteristics: We included studies with children (younger than 18 years of age) suffering from acute severe pain as a result of injury or medical illness. The target intervention was INF administered for pain relief compared with any other drug intervention for pain relief (e.g. intravenous morphine) or non-drug intervention (e.g. limb splinting, wound dressing) provided in the emergency setting. The evidence is current to January 2014. Key results: We identified three studies that included 313 children with acute severe pain resulting from broken bones of the upper and lower limbs. These trials compared INF versus morphine administered by a needle into a muscle (intramuscular morphine) or via a drip into a vein (intravenous morphine), as well as standard concentration INF versus high concentration INF. The collective study population in these trials consisted of children three to 15 years of age. Males accounted for approximately two-thirds of the overall study population. The review concluded that INF may be an effective analgesic for the treatment of children in acute moderate to severe pain, and its administration appears to cause minimal distress to children; however, the evidence is insufficient to permit judgement of the effects of INF compared with intramuscular or intravenous morphine. No serious adverse events (e.g. opiate toxicity, death) were reported. Limitations: Limitations of this review include the following: Few studies (three) were eligible for inclusion; no study examined the use of INF in children younger than three years of age; no study included children with pain resulting from a "medical" cause (e.g. abdominal pain seen in appendicitis); and all eligible studies were conducted in Australia. Consequently, the findings may not be generalizable to other healthcare settings, to children younger than three years of age and to those with pain from a "medical" cause.

Cochrane Summary: Nerve blocks for initial pain management of thigh bone fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Fractures (breaks) of the thigh bone can be very painful, particularly when a child arrives in a stressful emergency environment and is undergoing assessment. Moving the child to get X-rays or transferring the child to a special bed to support the leg in traction (keeping the leg straight) can cause additional pain, as can placing traction (a pulling force) on the broken thigh. This means that prompt provision of pain relief is an essential part of initial emergency management. This review investigated whether a nerve block, involving the injection of a freezing/numbing medication at the top of the thigh, would provide more effective pain relief than pain medicine given by mouth or into a vein (intravenously, e.g. morphine). We searched several medical databases and trial registries up to January 2013 and contacted researchers. We found one study that looked at the comparison we were interested in. This study was potentially biased, mainly because the care providers, parents and children were aware of the type of pain relief the children received. The study was small, involving 55 children aged 16 months to 15 years, and showed that the children who received one of the two main types of nerve block tended to have less pain after 30 minutes than those who received intravenous morphine for initial pain control. The nerve blocks led to some pain and redness at the injection site in a few cases, while intravenous morphine caused more serious problems such as depressed breathing (lack of oxygen), excessive sleepiness and vomiting in a small number of children. Moreover, children who had nerve blocks continued to have lower pain scores over a six-hour period with less need for additional pain relief. There was insufficient evidence to determine whether children or parents were more satisfied with one method of pain relief than the other. Use of resources (e.g. nursing time, cost of medications) was not measured. The quality of the study included in this review was low and so these conclusions are not certain. Further well designed studies investigating whether nerve blocks are more effective and safer than other means of pain relief are needed.

Cochrane Summary: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Antibiotics make little difference to children with an uncomplicated ear infection and ear pain. Some advocate ear drops with local anaesthetic such as amethocaine, benzocaine or lidocaine. Five trials (391 participants) were identified; two compared anaesthetic drops to placebo (inactive) drops; and three compared anaesthetic drops to herbal ear drops. There was no strong evidence that herbal ear drops were effective, but anaesthetic drops did provide better pain relief than the inactive drops. Only one trial looked at adverse reactions and reported no cases of ringing in the ears or unsteadiness when walking and three cases of very mild dizziness. Children in all the trials experienced a rapid, short-term reduction in pain after using ear drops. It is hard to know if this was the result of the natural course of the illness; the placebo effect of receiving treatment; the soothing effect of any liquid in the ear or the pharmacological effects of the ear drops themselves. Nevertheless, there is some evidence that when combined with oral pain medication, anaesthetic ear drops may help to relieve pain more rapidly in children aged three to 18 years. More good-quality trials are needed.

Procedural Pain English (10) French All (10)

Cochrane Summary: Sweet-tasting solutions for needle-related pain in infants up to one year of age

Visit

Kassab M, Foster JP, Foureu M, Fowle C

The use of needles that break the skin and cause pain is a common practice around the world with babies aged between one month and 12 months (Appendix 4). In thisreviewwe were interested in whether giving babies sugar-based solutions to taste when the needle breaks the skin will help reduce their pain. We found 14 separate studies that had asked this question. However, the differences between the studies were often too great to let us combine their findings. Overall, the studies show that different types of sugar-based solutions were effective but we were not able to confidently assert that there is strong evidence for this treatment in reducing pain. We did find some evidence that babies may not cry for as long if given sugar-based solutions. Thisreviewis broadly in agreement with two other reviews, one asking this question in younger children, and one in older children. There is a need for better studies in this field.

Cochrane Summary: Sucrose for analgesia in newborn infants undergoing painful procedures

Visit

Stevens B, Yamada J, Lee GY, Ohlsson A

Healthcare professionals need strategies to reduce newborn babies' pain. Sucrose (sugar) provides pain relief for newborn babies having painful events such as needles or heel pricks. Pain medicine is usually given for major painful events (such as surgery), but may not be given for more minor events (such as taking blood or needles). Pain medicine can be used to reduce pain but there are several other methods including sucking on a pacifier (dummy) with or without sucrose. Researchers have found that giving sucrose to babies decreases their crying time and behaviours such as grimacing. Moreresearchis needed to determine if giving repeated doses of sucrose is safe and effective, especially for very low birthweight infants or infants on respirators.

Cochrane Summary: Psychological interventions for needle-related procedural pain and distress in children and adolescents

Visit

Uman LS, Birni, KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR

Psychological interventions (for example, distraction, hypnosis, coping skills training) are treatments used to reduce pain and distress (anxiety and fear, or both) that children and adolescents experience while undergoing medical procedures involving needles. There is strong evidence that distraction and hypnosis are effective in reducing the pain and distress that children and adolescents experience during needle procedures. Distraction techniques can often be quite simple, such as reading the child stories, watching television, listening to music, or talking about something other than the needle. Sometimes parents or nurses are involved in helping to distract the child, although that is not always necessary. Interventions such as hypnosis may require someteachingby a trained professional for a child to learn. Other psychological treatments, such as explaining what is going to happen before or during the procedure (labelled 'providing information or preparation or both'), using virtual reality (for example, interactive video equipment, goggles, computers showing images, games, stories), or a combination of various strategies have been tested. Moreresearchis needed to know whether they are effective for reducing children's pain and distress during needles.

Cochrane Overview: The Cochrane Library and procedural pain in children: an overview of reviews

Visit

Curtis S, Wingert A, Ali S

Objective: To summarize Cochrane reviews assessing the effects of various interventions used for pain in non-neonatal children undergoing painful medical procedures.

Cochrane Summary: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Breastfeeding provides pain relief for newborn babies undergoing painful procedures. Medicine for pain relief is commonly given for major painful procedures, but may not be given for minor painful procedures such as blood sampling (by heel prick orvenepuncture). There are different forms of non-pharmacological strategies that may be used to reduce pain in babies, such as holding, swaddling them, sucking on a pacifier, or giving sweet solutions (such as sucrose or glucose). Different studies done in babies have shown that breastfeeding is a good way to reduce the pain babies feel when subjected to minor painful procedures. These studies have been done in full-term babies and they have shown that breastfeeding is effective by demonstrating that it reduces babies' crying time and reduces different pain scores that have been validated for babies. Breast milk given by syringe has not shown the sameefficacyas breastfeeding itself. No studies have been done in premature babies, and so new studies are needed to determine if the use of supplemental breast milk in these small babies is effective in reducing their pain.

Cochrane Summary: Non-pharmacological interventions for acute pain in infants

Visit

Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ah...

We examined 13 different types of commonly investigated non-pharmacological treatments (excluding breastmilk, sucrose, and music) to determine theirefficacyfor pain reactions after an acutely painful procedure (right after the needle ('pain reactivity') and less immediate pain reactions ('immediate pain-related regulation').Fifty-onerandomizedcontrolled trials were included involving 3396 participants. For preterm infants, there was sufficient evidence to recommend kangaroo care, sucking-related interventions, and swaddling/facilitated tucking interventions for both pain reactivity and immediate pain-related regulation. For neonates, there was sufficient evidence to recommend sucking-related interventions as an effective treatment for pain reactivity and immediate pain-related regulation.Rocking/holding was also found to be efficacious for neonatal immediate pain-related regulation.For older infants, there were no treatments reviewed that demonstrated sufficient evidence. Due to significant differences in the magnitude of treatment effects among studies (heterogeneity), some analyses that found a lack of treatment effect need to be interpreted with caution.

Cochrane Summary: Local anaesthesia (numbing medicine) that is directly applied to the skin may be used to provide pain control for repair of lacerations

Visit

Eidelman A, Weiss JM, Baldwin CL, Enu IK, McNicol ED, Carr DB

Paincontrolfor suturing of torn skin is conventionally achieved by injecting medication into the skin, which may itself cause pain. Topical anaesthetics are directly applied to the skin and are painless to administer. Cocaine was one of the first anaesthetics to be successfully applied topically. Concerns overadverse effectswith cocaine and the administrative burdens of dispensing a controlled substance led to the development of cocaine-free anaesthetics. There are numerous cocaine-free topical anaesthetics and these were found to be effective for enabling repair of dermal lacerations. We included 23randomizedcontrolled trials involving 3128 patients in thisreview. The small number of trials in each comparison group and theheterogeneityofoutcomemeasures precluded quantitativeanalysisofdatain all but oneoutcome, pain scores using a visual analogue scale. Additional studies are necessary to directly compare theeffectivenessof different formulations of topical anaesthetics. No serious side effects were reported in the studies included in thereviewfollowing use of cocaine-containing or cocaine-free topical anaesthetics.

Cochrane Summary: Sweet solution taste to ease injection needle pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

This is an updated version of the original Cochrane review published in Issue 10, 2011: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. We re-ran the search in October 2014. Review question: Do sweet tasting solutions reduce pain during needles in children aged from one to 16 years, compared to no treatment, water, other non-sweet solutions, or other interventions such as non-nutritive sucking (babies) or sweet foods or chewing gum (children), topical anaesthetics, music, and distraction? Background: Small amounts of sweet tasting sugar solutions given orally to babies before and during painful needles significantly reduces distress. However it was not known if the same pain-reducing effects of sweet solutions occurred in children older than one year of age. We therefore examined studies looking at pain-reducing effects of sweet solutions such as sucrose or glucose for painful needle procedures in children aged one to 16 years. Search date: We searched the literature for published and unpublished studies up to October 2014. Study characteristics: We found six studies focused on young children aged one to four years; two of these studies were included in the original review and four were new studies. The two studies included in the original review used a low concentration of sucrose, just 12%, which is not considered sweet enough for the pain reducing effects. Three of the four new studies were small pilot studies, conducted to inform full trials, and only one study of sweet solutions in young children included large numbers of children. When we compared results of all six studies, only two showed that sugar water (sucrose) reduced pain during injections. However, the four studies that showed no effect all included small numbers of children, therefore they were not considered large enough to detect significant differences in pain. Further well conducted trials with large enough numbers of young children are needed to work out if sweet taste effectively reduces their pain and distress during needles. For older school-aged children, there were two studies published by the same author, both of which were included in the original review. Neither study showed that sweet taste helped to reduce pain. As other studies show that strategies such as distraction and topical anaesthetics can effectively reduce needle pain in school-aged children, further studies of sweet taste for pain management in school-aged children are not warranted. Study funding sources: Of the six studies including young children, two did not acknowledge receipt of research funding. For the remaining four: a state-wide nursing fund supported two of the pilot studies, an internal research institute provided support for the remaining pilot study and another study was supported in part by a Maternal and Child Health grant. The two studies including school-aged children, conducted by the same author, were supported by a grant from the Canadian Institutes of Health Research.

Cochrane Summary: Venepuncture versus heel lance for blood sampling in term neonates

Visit

Shah V, Ohlsson A

In most countries, a blood sample from newborn babies is needed forscreeningtests. A heel lance is the standard way of taking blood, but it is a painful procedure with no optimal method of pain relief known. Thisreviewof trials found evidence thatvenepuncture, when done by a trained practitioner, caused less pain than heel lance. The use of a sweet tasting solution given to the baby prior to the event reduced pain further. The evidence includedoutcomemeasures using pain scales, how long the baby cried and how the mother rated their baby's pain.

Cochrane Summary: Tissue adhesives for traumatic lacerations in children and adults

Visit

Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N

Cuts (lacerations) often need to be closed to ensure proper healing, and prevent infection or unattractivescarring. Wounds may be closed with stitches (sutures), staples, tapes or glue (tissueadhesive). Thereviewfound that glue is an excellent substitute for stitches, staples or tapes to close simple cuts. Glue causes less pain, is quicker and needs no follow up for removal. A slightly higher number of cuts may break open (dehisce) after being glued, compared to cuts closed with stitches, staples or tapes. Though there are a few different types of glue available, no one glue seems to be superior.

Cochrane Summary: Sweet-tasting solutions for needle-related pain in infants up to one year of age

Visit

Kassab M, Foster JP, Foureu M, Fowle C

The use of needles that break the skin and cause pain is a common practice around the world with babies aged between one month and 12 months (Appendix 4). In thisreviewwe were interested in whether giving babies sugar-based solutions to taste when the needle breaks the skin will help reduce their pain. We found 14 separate studies that had asked this question. However, the differences between the studies were often too great to let us combine their findings. Overall, the studies show that different types of sugar-based solutions were effective but we were not able to confidently assert that there is strong evidence for this treatment in reducing pain. We did find some evidence that babies may not cry for as long if given sugar-based solutions. Thisreviewis broadly in agreement with two other reviews, one asking this question in younger children, and one in older children. There is a need for better studies in this field.

Cochrane Summary: Sucrose for analgesia in newborn infants undergoing painful procedures

Visit

Stevens B, Yamada J, Lee GY, Ohlsson A

Healthcare professionals need strategies to reduce newborn babies' pain. Sucrose (sugar) provides pain relief for newborn babies having painful events such as needles or heel pricks. Pain medicine is usually given for major painful events (such as surgery), but may not be given for more minor events (such as taking blood or needles). Pain medicine can be used to reduce pain but there are several other methods including sucking on a pacifier (dummy) with or without sucrose. Researchers have found that giving sucrose to babies decreases their crying time and behaviours such as grimacing. Moreresearchis needed to determine if giving repeated doses of sucrose is safe and effective, especially for very low birthweight infants or infants on respirators.

Cochrane Summary: Psychological interventions for needle-related procedural pain and distress in children and adolescents

Visit

Uman LS, Birni, KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR

Psychological interventions (for example, distraction, hypnosis, coping skills training) are treatments used to reduce pain and distress (anxiety and fear, or both) that children and adolescents experience while undergoing medical procedures involving needles. There is strong evidence that distraction and hypnosis are effective in reducing the pain and distress that children and adolescents experience during needle procedures. Distraction techniques can often be quite simple, such as reading the child stories, watching television, listening to music, or talking about something other than the needle. Sometimes parents or nurses are involved in helping to distract the child, although that is not always necessary. Interventions such as hypnosis may require someteachingby a trained professional for a child to learn. Other psychological treatments, such as explaining what is going to happen before or during the procedure (labelled 'providing information or preparation or both'), using virtual reality (for example, interactive video equipment, goggles, computers showing images, games, stories), or a combination of various strategies have been tested. Moreresearchis needed to know whether they are effective for reducing children's pain and distress during needles.

Cochrane Overview: The Cochrane Library and procedural pain in children: an overview of reviews

Visit

Curtis S, Wingert A, Ali S

Objective: To summarize Cochrane reviews assessing the effects of various interventions used for pain in non-neonatal children undergoing painful medical procedures.

Cochrane Summary: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Breastfeeding provides pain relief for newborn babies undergoing painful procedures. Medicine for pain relief is commonly given for major painful procedures, but may not be given for minor painful procedures such as blood sampling (by heel prick orvenepuncture). There are different forms of non-pharmacological strategies that may be used to reduce pain in babies, such as holding, swaddling them, sucking on a pacifier, or giving sweet solutions (such as sucrose or glucose). Different studies done in babies have shown that breastfeeding is a good way to reduce the pain babies feel when subjected to minor painful procedures. These studies have been done in full-term babies and they have shown that breastfeeding is effective by demonstrating that it reduces babies' crying time and reduces different pain scores that have been validated for babies. Breast milk given by syringe has not shown the sameefficacyas breastfeeding itself. No studies have been done in premature babies, and so new studies are needed to determine if the use of supplemental breast milk in these small babies is effective in reducing their pain.

Cochrane Summary: Non-pharmacological interventions for acute pain in infants

Visit

Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ah...

We examined 13 different types of commonly investigated non-pharmacological treatments (excluding breastmilk, sucrose, and music) to determine theirefficacyfor pain reactions after an acutely painful procedure (right after the needle ('pain reactivity') and less immediate pain reactions ('immediate pain-related regulation').Fifty-onerandomizedcontrolled trials were included involving 3396 participants. For preterm infants, there was sufficient evidence to recommend kangaroo care, sucking-related interventions, and swaddling/facilitated tucking interventions for both pain reactivity and immediate pain-related regulation. For neonates, there was sufficient evidence to recommend sucking-related interventions as an effective treatment for pain reactivity and immediate pain-related regulation.Rocking/holding was also found to be efficacious for neonatal immediate pain-related regulation.For older infants, there were no treatments reviewed that demonstrated sufficient evidence. Due to significant differences in the magnitude of treatment effects among studies (heterogeneity), some analyses that found a lack of treatment effect need to be interpreted with caution.

Cochrane Summary: Local anaesthesia (numbing medicine) that is directly applied to the skin may be used to provide pain control for repair of lacerations

Visit

Eidelman A, Weiss JM, Baldwin CL, Enu IK, McNicol ED, Carr DB

Paincontrolfor suturing of torn skin is conventionally achieved by injecting medication into the skin, which may itself cause pain. Topical anaesthetics are directly applied to the skin and are painless to administer. Cocaine was one of the first anaesthetics to be successfully applied topically. Concerns overadverse effectswith cocaine and the administrative burdens of dispensing a controlled substance led to the development of cocaine-free anaesthetics. There are numerous cocaine-free topical anaesthetics and these were found to be effective for enabling repair of dermal lacerations. We included 23randomizedcontrolled trials involving 3128 patients in thisreview. The small number of trials in each comparison group and theheterogeneityofoutcomemeasures precluded quantitativeanalysisofdatain all but oneoutcome, pain scores using a visual analogue scale. Additional studies are necessary to directly compare theeffectivenessof different formulations of topical anaesthetics. No serious side effects were reported in the studies included in thereviewfollowing use of cocaine-containing or cocaine-free topical anaesthetics.

Cochrane Summary: Sweet solution taste to ease injection needle pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

This is an updated version of the original Cochrane review published in Issue 10, 2011: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. We re-ran the search in October 2014. Review question: Do sweet tasting solutions reduce pain during needles in children aged from one to 16 years, compared to no treatment, water, other non-sweet solutions, or other interventions such as non-nutritive sucking (babies) or sweet foods or chewing gum (children), topical anaesthetics, music, and distraction? Background: Small amounts of sweet tasting sugar solutions given orally to babies before and during painful needles significantly reduces distress. However it was not known if the same pain-reducing effects of sweet solutions occurred in children older than one year of age. We therefore examined studies looking at pain-reducing effects of sweet solutions such as sucrose or glucose for painful needle procedures in children aged one to 16 years. Search date: We searched the literature for published and unpublished studies up to October 2014. Study characteristics: We found six studies focused on young children aged one to four years; two of these studies were included in the original review and four were new studies. The two studies included in the original review used a low concentration of sucrose, just 12%, which is not considered sweet enough for the pain reducing effects. Three of the four new studies were small pilot studies, conducted to inform full trials, and only one study of sweet solutions in young children included large numbers of children. When we compared results of all six studies, only two showed that sugar water (sucrose) reduced pain during injections. However, the four studies that showed no effect all included small numbers of children, therefore they were not considered large enough to detect significant differences in pain. Further well conducted trials with large enough numbers of young children are needed to work out if sweet taste effectively reduces their pain and distress during needles. For older school-aged children, there were two studies published by the same author, both of which were included in the original review. Neither study showed that sweet taste helped to reduce pain. As other studies show that strategies such as distraction and topical anaesthetics can effectively reduce needle pain in school-aged children, further studies of sweet taste for pain management in school-aged children are not warranted. Study funding sources: Of the six studies including young children, two did not acknowledge receipt of research funding. For the remaining four: a state-wide nursing fund supported two of the pilot studies, an internal research institute provided support for the remaining pilot study and another study was supported in part by a Maternal and Child Health grant. The two studies including school-aged children, conducted by the same author, were supported by a grant from the Canadian Institutes of Health Research.

Cochrane Summary: Venepuncture versus heel lance for blood sampling in term neonates

Visit

Shah V, Ohlsson A

In most countries, a blood sample from newborn babies is needed forscreeningtests. A heel lance is the standard way of taking blood, but it is a painful procedure with no optimal method of pain relief known. Thisreviewof trials found evidence thatvenepuncture, when done by a trained practitioner, caused less pain than heel lance. The use of a sweet tasting solution given to the baby prior to the event reduced pain further. The evidence includedoutcomemeasures using pain scales, how long the baby cried and how the mother rated their baby's pain.

Cochrane Summary: Tissue adhesives for traumatic lacerations in children and adults

Visit

Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N

Cuts (lacerations) often need to be closed to ensure proper healing, and prevent infection or unattractivescarring. Wounds may be closed with stitches (sutures), staples, tapes or glue (tissueadhesive). Thereviewfound that glue is an excellent substitute for stitches, staples or tapes to close simple cuts. Glue causes less pain, is quicker and needs no follow up for removal. A slightly higher number of cuts may break open (dehisce) after being glued, compared to cuts closed with stitches, staples or tapes. Though there are a few different types of glue available, no one glue seems to be superior.

Procedural Sedation English (1) French All (1)

Overview of Systematic Reviews: What works and what's safe in pediatric emergency procedural sedation: an overview of reviews

Visit

Hartling L, Milne A, Foisy M, Lang E, Sinclair D, Klassen TP, Evered L

This overview of systematic reviews examines the safety and efficacy of sedative agents commonly used for procedural sedation (propofol, ketamine, nitrous oxide, midazolam) in children in the ED or similar settings.

Overview of Systematic Reviews: What works and what's safe in pediatric emergency procedural sedation: an overview of reviews

Visit

Hartling L, Milne A, Foisy M, Lang E, Sinclair D, Klassen TP, Evered L

This overview of systematic reviews examines the safety and efficacy of sedative agents commonly used for procedural sedation (propofol, ketamine, nitrous oxide, midazolam) in children in the ED or similar settings.

Sepsis English (2) French All (2)

Cochrane Summary: Intravenous immunoglobulins for treating patients with severe sepsis and septic shock (2013)

Visit

Alejandria Marissa MLMA, D.; Dans Leonila, F.; Mantaring, I. I. I. Jacinto Blas

Objective: For this updated Cochrane review, we searched the medical literature databases to January 2012. We included 43 randomized controlled trials (RCTs); 25 were RCTs of polyclonal intravenous immunoglobulins (IVIGs) with 17 in adults (1958 participants) and eight in newborn infants (3831 participants) including a large polyclonal IVIG trial on infants with sepsis that was published in 2011. The remaining 18 trials (a total of 13,413 participants) were of monoclonal antibodies. Published: 2013.

Cochrane Summary: Human recombinant activated protein C for severe sepsis and septic shock in adult and paediatric patients (2012)

Visit

Mart-Carvajal Arturo JS, Ivan; Gluud, Christian; Lathyris, Dimitrios; Cardona...

Objective: In this updated Cochrane review we searched the databases until June 2012. We included six randomized clinical trials which involved 6781 people (6307 adult and 474 paediatric participants) with either a high or low risk of death. All trials had high risk of bias and were sponsored by the pharmaceutical industry (Eli Lilly). moreover, there is an increased risk of bleeding associated with its use. Published: 2012.

Cochrane Summary: Intravenous immunoglobulins for treating patients with severe sepsis and septic shock (2013)

Visit

Alejandria Marissa MLMA, D.; Dans Leonila, F.; Mantaring, I. I. I. Jacinto Blas

Objective: For this updated Cochrane review, we searched the medical literature databases to January 2012. We included 43 randomized controlled trials (RCTs); 25 were RCTs of polyclonal intravenous immunoglobulins (IVIGs) with 17 in adults (1958 participants) and eight in newborn infants (3831 participants) including a large polyclonal IVIG trial on infants with sepsis that was published in 2011. The remaining 18 trials (a total of 13,413 participants) were of monoclonal antibodies. Published: 2013.

Cochrane Summary: Human recombinant activated protein C for severe sepsis and septic shock in adult and paediatric patients (2012)

Visit

Mart-Carvajal Arturo JS, Ivan; Gluud, Christian; Lathyris, Dimitrios; Cardona...

Objective: In this updated Cochrane review we searched the databases until June 2012. We included six randomized clinical trials which involved 6781 people (6307 adult and 474 paediatric participants) with either a high or low risk of death. All trials had high risk of bias and were sponsored by the pharmaceutical industry (Eli Lilly). moreover, there is an increased risk of bleeding associated with its use. Published: 2012.

Severe Head Injury English (4) French All (4)

Summary: Haemostatic drugs for traumatic brain injury

Visit

Perel P, Roberts I, Shakur H, Thinkhamrop B, Phuenpathom N, Yutthakasemsunt S

We searched for randomised clinical trials looking at theeffectivenessof haemostatic drugs for reducingmortalityand disability in patients with traumatic brain injury.

Summary: Corticosteroids to treat brain injury

Visit

Alderson P, Roberts I

Thereviewauthors searched the medical literature to determine how effective and safe corticosteroids are for treating brain injury.

Summary: Hypothermia (body temperature cooling) for traumatic head injury

Visit

Sydenham E, Roberts I, Alderson P

Thisreviewincludes twenty-three randomised controlled trials involving 1614 patients with traumatic head injury. In eachtrial, the patients were randomly divided into two groups: one group remained at normal body temperature, and the other group was cooled to a maximum of 35 degrees Celsius (or 95 degrees Fahrenheit) for at least 12 consecutive hours. Information on death, disability, and pneumonia were evaluated for each trial.

Summary: Wearing a helmet dramatically reduces the risk of head and facial injuries for bicyclists involved in a crash, even if it involves a motor vehicle

Visit

Thompson DC, Rivara FP, Thompson R

Thereviewfound that wearing a helmet reduced theriskof head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle.

Summary: Haemostatic drugs for traumatic brain injury

Visit

Perel P, Roberts I, Shakur H, Thinkhamrop B, Phuenpathom N, Yutthakasemsunt S

We searched for randomised clinical trials looking at theeffectivenessof haemostatic drugs for reducingmortalityand disability in patients with traumatic brain injury.

Summary: Corticosteroids to treat brain injury

Visit

Alderson P, Roberts I

Thereviewauthors searched the medical literature to determine how effective and safe corticosteroids are for treating brain injury.

Summary: Hypothermia (body temperature cooling) for traumatic head injury

Visit

Sydenham E, Roberts I, Alderson P

Thisreviewincludes twenty-three randomised controlled trials involving 1614 patients with traumatic head injury. In eachtrial, the patients were randomly divided into two groups: one group remained at normal body temperature, and the other group was cooled to a maximum of 35 degrees Celsius (or 95 degrees Fahrenheit) for at least 12 consecutive hours. Information on death, disability, and pneumonia were evaluated for each trial.

Summary: Wearing a helmet dramatically reduces the risk of head and facial injuries for bicyclists involved in a crash, even if it involves a motor vehicle

Visit

Thompson DC, Rivara FP, Thompson R

Thereviewfound that wearing a helmet reduced theriskof head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle.

Suspected Physical Child Maltreatment English (2) French All (2)

Overview of Systematic Reviews: Systematic reviews of bruising in relation to child abuse-what have we learnt: an overview of review updates

Visit

Maguire S, Mann M

This overview examined systematic review evidence to answer the questions: can you age bruises accurately in children, and are there patterns of bruising in childhood which are either diagnostic or suggestive of abuse?

Overview of Systematic Reviews: What does the recent literature add to the identification and investigation of fractures in child abuse: an overview of review updates 2005-2013

Visit

Maguire S, Cowley L, Mann M, Kemp A

Objective: To identify additional studies that contribute to the evidence on distinguishing which fractures are indicative of abuse and optimizing the identification of occult fractures.

Overview of Systematic Reviews: Systematic reviews of bruising in relation to child abuse-what have we learnt: an overview of review updates

Visit

Maguire S, Mann M

This overview examined systematic review evidence to answer the questions: can you age bruises accurately in children, and are there patterns of bruising in childhood which are either diagnostic or suggestive of abuse?

Overview of Systematic Reviews: What does the recent literature add to the identification and investigation of fractures in child abuse: an overview of review updates 2005-2013

Visit

Maguire S, Cowley L, Mann M, Kemp A

Objective: To identify additional studies that contribute to the evidence on distinguishing which fractures are indicative of abuse and optimizing the identification of occult fractures.

Thoracoabdominal Trauma English (6) French All (6)

Blood-clot promoting drugs for acute traumatic injury

Visit

Ker K, Robert, I, Shakur H, Coats TJ,

This is an update of an existing Cochrane review, the last version was published in 2012.

Treatment of severe blunt pancreatic lesions in children

Visit

Haugaard MV, Wettergren A, Hillings JG, Gluud C, Penninga L,

This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials.

Preventing death from blood clots, the formation of blood clots and blood clots in the lungs in people who have had physical trauma

Visit

Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CH,

Sixteen studies involving 3,005 people are included in this review.

Should prophylactic antibiotics be used in patients with penetrating abdominal trauma?

Visit

Brand M, Grieve A,

No randomised controlled trials could be found that met the inclusion criteria for this review.

No evidence in favour of using ultrasound to aid diagnosis of patients with a 'blunt' injury to the abdomen

Visit

Stengel D, Bauwens K, Rademacher G, Ekkernkamp A, Gthoff C,

This Cochrane Review may be regarded as a review which provides the best available evidence for clinical practice guidelines and management recommendations.

Regular or selected use of computed tomography (CT) scanning to reduce deaths in people who have a high-energy blunt-traumatic injury

Visit

Van Vugt R, Keus F, Kool D, Deunk J, Edwards M,

We searched medical databases for publications of randomised controlled trials (a clinical study where participants are randomly allocated into treatment groups) comparing the usual approach versus selected use of CT scanning.

Blood-clot promoting drugs for acute traumatic injury

Visit

Ker K, Robert, I, Shakur H, Coats TJ,

This is an update of an existing Cochrane review, the last version was published in 2012.

Treatment of severe blunt pancreatic lesions in children

Visit

Haugaard MV, Wettergren A, Hillings JG, Gluud C, Penninga L,

This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials.

Preventing death from blood clots, the formation of blood clots and blood clots in the lungs in people who have had physical trauma

Visit

Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CH,

Sixteen studies involving 3,005 people are included in this review.

Should prophylactic antibiotics be used in patients with penetrating abdominal trauma?

Visit

Brand M, Grieve A,

No randomised controlled trials could be found that met the inclusion criteria for this review.

No evidence in favour of using ultrasound to aid diagnosis of patients with a 'blunt' injury to the abdomen

Visit

Stengel D, Bauwens K, Rademacher G, Ekkernkamp A, Gthoff C,

This Cochrane Review may be regarded as a review which provides the best available evidence for clinical practice guidelines and management recommendations.

Regular or selected use of computed tomography (CT) scanning to reduce deaths in people who have a high-energy blunt-traumatic injury

Visit

Van Vugt R, Keus F, Kool D, Deunk J, Edwards M,

We searched medical databases for publications of randomised controlled trials (a clinical study where participants are randomly allocated into treatment groups) comparing the usual approach versus selected use of CT scanning.

Upper Extremity Fractures English (2) French All (2)

Cochrane Summary: Conservative interventions for shaft fractures of the forearm bones in children

Visit

Madhuri V, Dutt V, Gahukamble AD, Tharyan P

The forearm consists of two bones, the radius and the ulna. Fractures (broken bones) in the middle portion (shaft) of one or both of these bones are common injuries in children. Most of these fractures are treated conservatively (i.e. without surgery). Conservative treatment usually involves gently putting the broken bone back into place (reduction). Part of the arm is then put in a cast to protect and support the broken bones while they heal. There are different ways of immobilising the injured arm. For example, some casts include the elbow whereas others do not. When casts include the elbow, the elbow may be in a bent or extended position. While these fractures usually heal, the results are not always satisfactory and sometimes there are complications. This review aimed to find out which conservative treatment methods give the best results for children with these fractures by looking at the evidence from randomised controlled trials comparing different conservative interventions. While we found two completed trials, both were published only in conference abstracts that failed to provide any usable data. We also found two ongoing trials. In all, the review found no evidence from randomised trials to inform on the best ways to treat these fractures.

Cochrane Summary: Surgical treatment for forearm fractures in children (fractures involving the shafts of the radius and ulna)

Visit

Abraham A, Kumar S, Chaudhry S, Ibrahim T

Fractures of the shafts of the forearm bones in children are common injuries and occur after a fall on an outstretched hand. There are two bones in the forearm: the radius and the ulna. After a fall either one or both bones may fracture. The shape of forearm bones are important for the twisting motion of the hand, such as in receiving change from a shop keeper with an open palm (supination) or turning a key in a door (turning the palm facing down - pronation). Treatment of the forearm fracture aims to restore the shape of the bones such that supination and pronation ability is restored. The first stage of treatment involves manipulating (setting) the bones to the correct shape. This is usually done under anaesthesia. The second stage involves stabilising the fractured bones either with a plaster cast (conservative treatment) or metal implants (surgical treatment). This review aimed to examine the evidence from randomised controlled trials comparing conservative versus surgical methods and trials comparing different surgical methods for treatment of these fractures. We hoped to find which are the best methods in terms of function and complications. In spite of a thorough search we found no evidence from properly conducted studies to help inform decisions on treatment of these fractures.

Cochrane Summary: Conservative interventions for shaft fractures of the forearm bones in children

Visit

Madhuri V, Dutt V, Gahukamble AD, Tharyan P

The forearm consists of two bones, the radius and the ulna. Fractures (broken bones) in the middle portion (shaft) of one or both of these bones are common injuries in children. Most of these fractures are treated conservatively (i.e. without surgery). Conservative treatment usually involves gently putting the broken bone back into place (reduction). Part of the arm is then put in a cast to protect and support the broken bones while they heal. There are different ways of immobilising the injured arm. For example, some casts include the elbow whereas others do not. When casts include the elbow, the elbow may be in a bent or extended position. While these fractures usually heal, the results are not always satisfactory and sometimes there are complications. This review aimed to find out which conservative treatment methods give the best results for children with these fractures by looking at the evidence from randomised controlled trials comparing different conservative interventions. While we found two completed trials, both were published only in conference abstracts that failed to provide any usable data. We also found two ongoing trials. In all, the review found no evidence from randomised trials to inform on the best ways to treat these fractures.

Cochrane Summary: Surgical treatment for forearm fractures in children (fractures involving the shafts of the radius and ulna)

Visit

Abraham A, Kumar S, Chaudhry S, Ibrahim T

Fractures of the shafts of the forearm bones in children are common injuries and occur after a fall on an outstretched hand. There are two bones in the forearm: the radius and the ulna. After a fall either one or both bones may fracture. The shape of forearm bones are important for the twisting motion of the hand, such as in receiving change from a shop keeper with an open palm (supination) or turning a key in a door (turning the palm facing down - pronation). Treatment of the forearm fracture aims to restore the shape of the bones such that supination and pronation ability is restored. The first stage of treatment involves manipulating (setting) the bones to the correct shape. This is usually done under anaesthesia. The second stage involves stabilising the fractured bones either with a plaster cast (conservative treatment) or metal implants (surgical treatment). This review aimed to examine the evidence from randomised controlled trials comparing conservative versus surgical methods and trials comparing different surgical methods for treatment of these fractures. We hoped to find which are the best methods in terms of function and complications. In spite of a thorough search we found no evidence from properly conducted studies to help inform decisions on treatment of these fractures.

Urinary Tract Infections English (9) French All (9)

Cochrane Summary: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Visit

Shaikh N, Borrell JL, Evron J, Leeflang MM

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non-invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow-up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C-reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C-reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

Cochrane Summary: Are oral antibiotics as effective as a combination of injected and oral antibiotics for kidney infections in children?

Visit

Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC

We wanted to find out if oral antibiotics were as effective as combined oral and injected antibiotics to treat children for kidney infection. This review updates our previous investigations published in 2003, 2005 and 2007. This review included evidence from 27 studies that involved 4452 children. The last literature search date was April 2014. This update included evidence from three new studies and from one study that was previously excluded. Review results suggested that children aged over one month with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten or amoxicillin/clavulanic acid) or with short courses (two to four days) of intravenous (IV) therapy followed by oral therapy. If IV therapy with aminoglycosides is needed, single daily dosing is safe and effective.

Cochrane Summary: Antibiotics for covert bacteriuria in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M

Covert bacteriuria occurs when bacteria are found in urine either during routine screening or incidentally during other investigations. Unlike urinary tract infections, children with covert bacteriuria do not appear to have symptoms at the time of diagnosis. There is uncertainty about whether antibiotic treatment can help to clear infection, reduce recurrence, or prevent kidney damage. Any harmful effects of providing treatment also need to be identified and understood. We identified three studies reporting the results on 460 girls. There was insufficient evidence about the harms and benefits of treatments to draw reliable conclusions, but it appears that antibiotic treatment is not likely to benefit children in the long term.

Cochrane Summary: Antibiotics for lower urinary tract infection in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. The most commonly presenting infection of the urinary tract is known as cystitis and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. This review identified 16 studies investigating antibiotics for UTI in children. Results suggest that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments; there was not enough data to draw conclusions about other treatment durations, or effectiveness of particular antibiotics. Although antibiotic treatment is effective for children with UTI, there are insufficient data to recommend any specific regimen.

Cochrane Summary: Long-term antibiotics for preventing recurrent urinary tract infection in children

Visit

Williams G, Craig JC

Bladder and kidney infections (urinary tract infection - UTI) are common in children, especially girls. They cause an uncomfortable illness that can include vomiting, fever and tiredness. In some children kidney damage may occur, as can repeat illnesses. With repeated infections the risk of kidney damage increases. Some doctors prescribe long-term antibiotics to try to prevent infections recurring, but this may cause the child to be unwell in other ways, e.g. vomiting. This review of randomised controlled trials (RCTs) found evidence that long-term antibiotics did reduce the risk of more symptomatic infections but the benefit is small and must be weighed against the likelihood that future infections may be with bacteria that are resistant to the antibiotic given.

DARE Quality-assessed Reviews: Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis

Visit

Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC

This review assessed rapid urine tests for the diagnosis of urinary tract infection in children and concluded that no one test could identify all urinary tract infections without urine culture, but Gram-stain microscopy was the best single test. Dipstick tests should be considered positive if either leucocyte esterase or nitrite was positive. These conclusions are likely to be reliable.

DARE Quality-assessed Reviews: Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever

Visit

Sanders S, Barnett A, Correa-Velez I, Coulthard M, Doust J

The review assessed the accuracy of C-reactiveproteinfor diagnosingbacterial infectionsin febrile children and used robust reviewing and meta-analytic methods. The authors' conclusion that C-reactive protein provided moderate and independent information for ruling-in and ruling-out seriousbacterial infection, but cannot be used alone to exclude bacterial infection, is likely to be reliable.

DARE Quality-assessed Reviews: Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Visit

Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J

This review concluded that for the diagnosis of urinary tract infection (UTI), dipstick negative for both leucocyte esterase and nitrite or negative microscopic analysis for pyuria of a clean voided urine, bag or nappy/pad specimen may be used to rule out UTI, and that combinations of positive tests could similarly be used to rule in UTI. These conclusions are likely to be reliable.

Cochrane Summary: Short courses of antibiotics (2-4 days) are as effective as longer treatment for bladder infections in children

Visit

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

Bladder and kidney infections (urinary tract infections - UTI) are common in children. Bladder infections cause pain on passing urine and frequency of urination. Some children keep getting repeat bouts. Standard courses of antibiotics (7-10 days) are used to clear the infection. Shorter courses may reduce adverse effects and costs, but there has been concern that they might reduce the chances of clearing the infection and increase the risk of recurrence. A review of studies found that short courses of antibiotics (2-4 days) used for bladder infections are as effective as standard courses at clearing UTI, with no increase in recurrence.

Cochrane Summary: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Visit

Shaikh N, Borrell JL, Evron J, Leeflang MM

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non-invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow-up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C-reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C-reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

Cochrane Summary: Are oral antibiotics as effective as a combination of injected and oral antibiotics for kidney infections in children?

Visit

Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC

We wanted to find out if oral antibiotics were as effective as combined oral and injected antibiotics to treat children for kidney infection. This review updates our previous investigations published in 2003, 2005 and 2007. This review included evidence from 27 studies that involved 4452 children. The last literature search date was April 2014. This update included evidence from three new studies and from one study that was previously excluded. Review results suggested that children aged over one month with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten or amoxicillin/clavulanic acid) or with short courses (two to four days) of intravenous (IV) therapy followed by oral therapy. If IV therapy with aminoglycosides is needed, single daily dosing is safe and effective.

Cochrane Summary: Antibiotics for covert bacteriuria in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M

Covert bacteriuria occurs when bacteria are found in urine either during routine screening or incidentally during other investigations. Unlike urinary tract infections, children with covert bacteriuria do not appear to have symptoms at the time of diagnosis. There is uncertainty about whether antibiotic treatment can help to clear infection, reduce recurrence, or prevent kidney damage. Any harmful effects of providing treatment also need to be identified and understood. We identified three studies reporting the results on 460 girls. There was insufficient evidence about the harms and benefits of treatments to draw reliable conclusions, but it appears that antibiotic treatment is not likely to benefit children in the long term.

Cochrane Summary: Antibiotics for lower urinary tract infection in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. The most commonly presenting infection of the urinary tract is known as cystitis and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. This review identified 16 studies investigating antibiotics for UTI in children. Results suggest that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments; there was not enough data to draw conclusions about other treatment durations, or effectiveness of particular antibiotics. Although antibiotic treatment is effective for children with UTI, there are insufficient data to recommend any specific regimen.

Cochrane Summary: Long-term antibiotics for preventing recurrent urinary tract infection in children

Visit

Williams G, Craig JC

Bladder and kidney infections (urinary tract infection - UTI) are common in children, especially girls. They cause an uncomfortable illness that can include vomiting, fever and tiredness. In some children kidney damage may occur, as can repeat illnesses. With repeated infections the risk of kidney damage increases. Some doctors prescribe long-term antibiotics to try to prevent infections recurring, but this may cause the child to be unwell in other ways, e.g. vomiting. This review of randomised controlled trials (RCTs) found evidence that long-term antibiotics did reduce the risk of more symptomatic infections but the benefit is small and must be weighed against the likelihood that future infections may be with bacteria that are resistant to the antibiotic given.

DARE Quality-assessed Reviews: Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis

Visit

Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC

This review assessed rapid urine tests for the diagnosis of urinary tract infection in children and concluded that no one test could identify all urinary tract infections without urine culture, but Gram-stain microscopy was the best single test. Dipstick tests should be considered positive if either leucocyte esterase or nitrite was positive. These conclusions are likely to be reliable.

DARE Quality-assessed Reviews: Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever

Visit

Sanders S, Barnett A, Correa-Velez I, Coulthard M, Doust J

The review assessed the accuracy of C-reactiveproteinfor diagnosingbacterial infectionsin febrile children and used robust reviewing and meta-analytic methods. The authors' conclusion that C-reactive protein provided moderate and independent information for ruling-in and ruling-out seriousbacterial infection, but cannot be used alone to exclude bacterial infection, is likely to be reliable.

DARE Quality-assessed Reviews: Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Visit

Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J

This review concluded that for the diagnosis of urinary tract infection (UTI), dipstick negative for both leucocyte esterase and nitrite or negative microscopic analysis for pyuria of a clean voided urine, bag or nappy/pad specimen may be used to rule out UTI, and that combinations of positive tests could similarly be used to rule in UTI. These conclusions are likely to be reliable.

Cochrane Summary: Short courses of antibiotics (2-4 days) are as effective as longer treatment for bladder infections in children

Visit

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

Bladder and kidney infections (urinary tract infections - UTI) are common in children. Bladder infections cause pain on passing urine and frequency of urination. Some children keep getting repeat bouts. Standard courses of antibiotics (7-10 days) are used to clear the infection. Shorter courses may reduce adverse effects and costs, but there has been concern that they might reduce the chances of clearing the infection and increase the risk of recurrence. A review of studies found that short courses of antibiotics (2-4 days) used for bladder infections are as effective as standard courses at clearing UTI, with no increase in recurrence.