Ahmad 2006.

Methods	Randomised controlled trial carried out over 12 months in Malawi
Participants	160 children of both sexes and aged 2 months to 12 years presenting to a paediatric emergency department in a generalised seizure. Exclusion criteria: features of hepatic or hypertensive encephalopathy or organophosphate poisoning, children who had received an anticonvulsant within 1 hour of presentation
Interventions	Intranasal lorazepam versus intramuscular paraldehyde
Outcomes	Seizure cessation Incidence of cardiorespiratory depression Need for further anti‐convulsant/s
Notes	Study conducted in Africa with a high proportion of children with either cerebral malaria or meningitis. Consequently, not readily generalisable to western populations
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Blocked randomisation was done in advance by a computer that randomly generated a table of numbers in batches of ten" Comment: adequate randomisation
Allocation concealment (selection bias)	Low risk	Quote: " treatment allocations were sealed in unmarked identical envelopes. Investigators were masked to these allocations before the point of patient treatment. Quote: adequate concealment
Blinding (performance bias and detection bias) All outcomes	Low risk	Study unblinded, but blinding would have been difficult due to the different routes of administration of the 2 study drugs. This is not likely to have affected outcome
Incomplete outcome data (attrition bias) All outcomes	Low risk	All randomised participants were included in the final analysis
Selective reporting (reporting bias)	Low risk	All prespecified outcomes were reported in the Results section
Other bias	High risk	A high proportion of the children recruited had either cerebral malaria or meningitis. These comorbidities may have impacted upon the results