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The efficacy of benzodiazepines as acute anxiolytics in children: A meta‐analysis
Author(s) -
Kuang Heide,
Johnson Jessica A.,
Mulqueen Jilian M.,
Bloch Michael H.
Publication year - 2017
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22643
Subject(s) - tolerability , irritability , benzodiazepine , meta analysis , anxiety , medicine , strictly standardized mean difference , randomized controlled trial , subgroup analysis , anti anxiety agents , anesthesia , psychiatry , adverse effect , receptor
Objective Current practice guidelines do not recommend benzodiazepines for acute management of anxiety disorders in pediatric patients. However, in procedural settings, benzodiazepines are commonly used to relieve acute preprocedural stress. This meta‐analysis examines the efficacy and tolerability of benzodiazepines as short‐term anxiolytics in children. Method PubMed was searched for randomized controlled trials assessing the efficacy of benzodiazepines as short‐term anxiolytics in pediatric patients. Twenty‐one trials involving 1,416 participants were included. A fixed effects model was used to examine the standardized mean difference of improvement in anxiety levels compared to control conditions. In stratified subgroup and meta‐regression, the effect of the specific agent, dose, timing, and setting of benzodiazepine treatment was examined. Results A significant benefit was seen for benzodiazepines compared to control (standardized mean difference = 0.71 [95% confidence interval, 0.60–0.82], k = 24, z = 12.7, P < .001). There was also funnel plot asymmetry in this meta‐analysis, suggesting some evidence of publication bias. Moderator analyses found that when benzodiazepines were used in dental or nonoperating room procedures, they were more effective than when they were used in operating room procedures (test for subgroup differences Q 2 = 6.34, P = .04). Tolerability analysis revealed there was no significant difference in the risk of developing irritability or behavioral changes between benzodiazepine and control groups. Conclusions Benzodiazepines are effective and well‐tolerated when used as short‐term anxiolytics in procedural settings for pediatric patients. Further research is needed to determine whether benzodiazepines are effective in pediatric anxiety disorders.