Evidence map›Paper›PMID 41904318›Full record

SynthesisPediatric research2026

Efficacy, safety, route of administration of midazolam and diazepam for pediatric status epilepticus: systematic review, meta-analysis, and trial sequential analysis.

Ahmed Kertam, Nourhan Hatem, Omar Mahmood Al-Azzawi, Long H Tu, Ahmed Harb, Mohamed Sabri Hassanin, Israa Abdeen, Mariam Mostafa, Salma Allam, Mohamed Mostafa and 1 more

Erratum issuedAbstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.

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

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

Ahmed Kertam *Faculty of Medicine, Ain Shams University, Cairo, Egypt. akertam@gmail.com.ORCID http://orcid.org/0000-0002-9038-7901
Nourhan Hatem *Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Omar Mahmood Al-AzzawiStudent, Faculty of Pharmacy, İstinye University,, Istanbul, Türkiye.
Long H TuDepartment of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
Ahmed HarbFaculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohamed Sabri HassaninFaculty of Medicine, Al-Azhar University, Cairo, Egypt.
Israa AbdeenFaculty of Medicine, Ain Shams University, Cairo, Egypt.
Mariam MostafaFaculty of Medicine, 6th of October University, Cairo, Egypt.
Salma AllamFaculty of medicine, Galala University, Suez, Egypt.
Mohamed MostafaFaculty of Medicine, Ain Shams University, Cairo, Egypt.
Yehia NabilFaculty of Medicine, Zagazig University, Zagazig, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundStatus epilepticus (SE) is a life-threatening pediatric emergency requiring rapid anticonvulsants. While midazolam and diazepam are standard benzodiazepines, their comparative efficacy across various administration routes remains debated. We synthesized high-quality evidence to guide clinical protocols.

methodsWe searched PubMed, Scopus, Web of Science, and Cochrane for randomized controlled trials comparing buccal, intramuscular, and intravenous formulations. We evaluated treatment outcomes including therapeutic success (seizure cessation), recurrence, and drug-related side effects. We employed meta-analysis, trial sequential analysis (TSA), and GRADE to ensure the robustness of the evidence.

resultsNine RCT studies (n = 1135 children) were included. Midazolam demonstrated superior therapeutic success (RR = 1.13, 95% CI 1.03-1.25, p = 0.01), with TSA confirming conclusive benefit for the buccal route (RR = 1.30, p = 0.002). Midazolam significantly reduced treatment failure (RR = 0.74, 95% CI 0.57-0.95, p = 0.02) and seizure recurrence (RR = 0.51, p = 0.04). Time-to-cessation was shorter with non-intravenous routes (MD = -2.39 min, p = 0.01). Safety profiles regarding respiratory depression were comparable between groups.

conclusionMidazolam is the preferred first-line anticonvulsant for pediatric status epilepticus. It offers superior therapeutic success, lower failure rates, and reduced recurrence, particularly via buccal and intramuscular routes. Given comparable safety, this evidence strongly supports updating emergency medical services guidelines to prioritize non-intravenous midazolam. IMPACT: Midazolam demonstrates superior efficacy over diazepam, particularly via buccal and intramuscular routes. It addresses critical prehospital delays by bypassing the high failure rates associated with pediatric vascular access. Intramuscular administration matches intravenous efficacy while enabling immediate intervention without specialized equipment. Additionally, buccal and nasal formulations represent the most cost-effective non-intravenous rescue options available. Guidelines must prioritize these practical routes for EMS settings, necessitating policy updates to remove insurance barriers.

Identifiers

PMID41904318

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Registered trials

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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.