Summary of findings for the main comparison. Intravenous immunoglobulin with or without standard care compared with standard care alone or placebo for children with acute encephalitis.
| Intravenous immunoglobulin ± standard care compared with standard care alone or placebo for children with acute encephalitis | ||||||
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Patient or population: children with acute encephalitis Settings: secondary and tertiary care Intervention: intravenous immunoglobulin Comparison: placebo or standard care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk (control) | Corresponding risk (intervention) | |||||
| Standard care or placebo | IVIG (± standard care) | |||||
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Significant disability assessed using Liverpool Outcome Score RR (M‐H, random‐effects analysis, 95% CI) Follow‐up: 3‐6 months |
364 per 1000 | 273 per 1000 (80 to 945) |
RR 0.75 (0.22 to 2.60) |
22 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c,d,e | Unclear risk of detection bias and high risk of publication bias. Small sample size. Study not powered on primary outcome. |
|
≥ 1 serious adverse event RR (M‐H, random‐effects analysis, 95% CI) |
91 per 1000 | 91 per 1000 (6 to 1000) |
RR 1.00 (0.07 to 14.05) |
22 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c,d,e | Unclear risk of detection bias and high risk of publication bias. Small sample size. Study not powered on primary outcome. |
|
Length of hospital stay (MD, random‐effects analysis, 95% CI) |
The mean length of hospital stay was 13.26 | MD 4.54 lower (7.47 to 1.61 lower) | ‐ | 116 (2 RCTs) | ⊕⊝⊝⊝ Very lowd,f,g,h,i | Unclear risk of selection bias in 1 study contributing to this outcome assessment. Unclear risk of allocation concealment, performance and detection bias in both studies. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; IVIG: intravenous immunoglobulin; M‐H: Mantel‐Haenszel; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aUnclear risk of detection bias.
bConflicts of interest could not be excluded.
cStudy of Japanese encephalitis, therefore, results not generalisable to other forms of encephalitis.
dSmall sample size in studies contributing to this outcome.
eSome predefined outcomes were not reported.
fUnclear risk of performance and detection bias in both studies contributing to this outcome.
gUnclear risk of selection bias in one study contributing to this outcome assessment.
hHigh proportion of variation in point estimates.
iBoth studies included only children with viral encephalitis, therefore, results not generalisable to other forms of encephalitis.