Evidence map›Paper›PMID 39198327›Full record

SynthesisCJEM2024

Intranasal midazolam for procedural distress in children in the emergency department: a systematic review and meta-analysis.

Jie Yi Wang, Kathy Speechley, Kelly K Anderson, George Gainham, Samina Ali, Evelyn D Trottier, Vikram Sabhaney, Anna Heath, Christy Sich, Arielle Forbes and 1 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in CJEM, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Incidence and predictors of nonresponse to intranasal midazolam in children undergoing laceration repair.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025
    Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jie Yi WangDivision of Paediatric Emergency Medicine, Department of Paediatrics, Western University, London, ON, Canada.
Kathy SpeechleyDivision of Paediatric Emergency Medicine, Department of Paediatrics, Western University, London, ON, Canada.
Kelly K AndersonDepartment of Epidemiology & Biostatistics, Western University, London, ON, Canada.
George GainhamDepartment of Epidemiology & Biostatistics, Western University, London, ON, Canada.
Samina AliDepartment of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
Evelyn D TrottierCentre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
Vikram SabhaneyBC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Anna HeathChild Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
Christy SichWestern Libraries, Western University, London, ON, Canada.
Arielle ForbesDepartment of Emergency Medicine, London Health Sciences Center, London, ON, Canada.
Naveen PoonaiDivision of Paediatric Emergency Medicine, Department of Paediatrics, Western University, London, ON, Canada. naveen.poonai@lhsc.on.ca.ORCID 0000-0003-1540-0413

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesIntranasal (IN) midazolam is the most common anxiolytic for children in the emergency department (ED), but evidence of benefit is conflicting. We synthesized the evidence on IN midazolam for procedural distress in children undergoing ED painful procedures.

methodsWe included trials involving painful ED procedures in children 0-18 years involving IN midazolam. Primary outcome was procedural distress. We summarized results using Tricco et al.'s classification of "neutral" (p ≥ 0.05), "favorable," and "unfavorable" (p < 0.05), supporting IN midazolam or comparator, respectively, or "indeterminate" (unable to judge). Where possible, we pooled results using meta-analysis. Methodologic quality of evidence was evaluated using Cochrane Collaboration's risk of bias tool and GRADE system.

resultsWe included 41 trials (n = 2973 participants). Thirty trials involved intravenous insertion. IN midazolam was superior to placebo (RR = 7.2; 95% CI: 3.43, 15.25; 3 trials; I

conclusionsThere is limited methodologically rigorous evidence that IN midazolam is better than placebo for IV insertion and laceration repair. At the doses studied, preliminary evidence suggests that IN dexmedetomidine may be superior to IN midazolam for both IV insertion and laceration repair.

Indexed as

Administration, IntranasalEmergency Service, HospitalMidazolamAdolescentAnti-Anxiety AgentsChildChild, PreschoolHumansHypnotics and SedativesInfantProcedural PainAnti-Anxiety AgentsHypnotics and SedativesMidazolamAnxiolysisEmergency departmentIntranasal midazolamPediatrics

Identifiers

PMID39198327

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.