Evidence map›Paper›PMID 40799357›Full record

ArticleNeurology. Clinical practice2025

Insights From the International Consensus on Neuro-Irritability in Pediatric Palliative Care: Expanding the Known, Challenging the Unknown.

Anna Mercante, Harold Siden, Justin Nathaniel Baker, Danai Papadatou, Huda Abu-Saad Huijer, Boris Zernikow, Julie Hauer, Franca Benini, Neuro-Irritability and Pediatric Palliative Care Group

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In one paragraph

Article in Neurology. Clinical practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing 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

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Anna MercanteDepartment of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy.ORCID https://orcid.org/0009-0008-5142-6315
Harold SidenDepartment of Pediatrics, Canuck Place Children's Hospice, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.ORCID https://orcid.org/0000-0001-8419-8912
Justin Nathaniel BakerDivision of Quality of Life and Pediatric Palliative Care, Department of Pediatrics, Stanford School of Medicine and Stanford Medicine Children's Health, Stanford University, CA.ORCID https://orcid.org/0000-0002-6584-6483
Danai PapadatouDepartment of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece.ORCID https://orcid.org/0000-0002-2743-0241
Huda Abu-Saad HuijerFaculty of Health Sciences, University of Balamand, Lebanon.ORCID https://orcid.org/0000-0001-6959-9419
Boris ZernikowPedScience Research Institute, Datteln, Germany.ORCID https://orcid.org/0000-0001-5875-3775
Julie HauerDivision of General Pediatrics, Boston Children's Hospital, MA; and.ORCID https://orcid.org/0000-0003-2881-5917
Franca BeniniDepartment of Women's and Children's Health, Pediatric Palliative Care, Pain Service, University Hospital of Padua, Italy.ORCID https://orcid.org/0000-0001-8312-6976
Neuro-Irritability and Pediatric Palliative Care Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and Objectives: Many children with severe neurologic impairment (SNI) have complex care coordination and management needs, making them eligible for pediatric palliative care (PPC). Indeed, SNI is associated with numerous, often simultaneous, distressing symptoms. Among these, neuro-irritability is particularly common and impactful. The limited understanding of this condition poses a challenge for clinicians in terms of recognition and management, constituting a significant barrier to adequate care. Given the lack of scientific evidence and clinical practice guidelines, we initiated an international and multidisciplinary project to obtain consensus-based guidance on pediatric neuro-irritability. Methods: A panel of 66 experts from across the world was selected to participate in a 2-round Delphi method. The aim of this process was to gather their opinions and insights in the areas of Definition, Assessment, Monitoring, and Treatment of neuro-irritability as encountered in PPC. Panelists were asked to indicate their level of agreement with a series of statements through an online survey, using a 5-point Likert scale. Consensus on a particular item was defined as achieving ≥75% of (dis)agreement among participants. Results: A total of 55 statements were endorsed during the 2 voting sessions. In addition to defining the fundamental features of neuro-irritability, several core elements of the diagnostic process and follow-up protocol were developed. Recommendations on the pharmacological and nonpharmacological approaches are also provided. Discussion: This first international expert consensus aims to support physicians in identifying and addressing neuro-irritability in children with SNI. Our work provides a framework to enhance knowledge on neuro-irritability and advance clinical practice, identifying unmet needs and areas of uncertainty that warrant further research efforts.

Identifiers

PMID40799357
PMCPMC12342229

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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.