Systematic Review Critique: Management of the SE in Children
Table of Contents
The Main Issue of the Research
The study by Riviello et al. (2006) was set to explore the existing evidence on the assessment of children with the status epilepticus (SE). The article uses adopted definition of SE as “a 30-minute duration of seizures based on previous studies that found evidence of brain injury in adult monkeys after 45 to 60 minutes of continuous seizures” (Riviello et al., 2006, p.1543). SE in children is a life threatening condition that requires early recognition and immediate medical attention. Further, in the highlight of the main issue of the research, authors discuss different classes of seizures inherent in SE and the ways they manifest in patients. In brief, the study by Riviello et al. (2006) extensively identifies SE, its classes, etiology and manifestation in children, and possible management measures.
Elements of the Review
The topic and abstract systematically introduce the main issue of the study: SE in children. Riviello et al. (2006) spent considerable part of the report on the explanation of SE, its different classes, and manifestation in children. Furthermore, the study provides the literature review of the key themes that highlight the main issues of the research. The review section is divided into introduction (defining SE and highlighting its classes, etiology and manifestation in children), and description of a process (explaining how the research team performed literature search to identify the materials that were used in the review). The section on the analysis of the evidence discusses common themes and issues found in the literature, and their relevance to SE in children. It is significant to note that the literature reviewed is discussed by highlighting the evidence, conclusion, and recommendations. The fact that authors reviewed over sixty materials on SE in children validates their findings. Concisely, the study comprises of introduction, review of literature, methodology, results and recommendations with each section succinctly contributing to the research issue (SE in children).
Validity of the Final Results
Validity of results of any study depends on the organization and strength of the research methodology, and its consistency with literature findings (Creswell, 2009). From the methodology section, it is evident that the researchers used academic materials from credible sources. The literature review conducted at MEDLINE and the University of Minnesota Library confirms the credibility of the materials used. In addition, extensive inclusion and exclusion criteria used for identifying academic materials published between 1970 and 2005 affirms the validity of the review findings.
Twenty five articles identified for the final review were further analyzed by individual committee members largely focusing on the titles and abstracts in terms of relevance and content. Information from each of the articles prepared for the final review was scrutinized in terms of the total number of participants (patients), their age, episodes of SE (where given), the nature of the subject selection, methodology used for the case finding, inclusion and exclusion criteria used by authors, etiology and the laboratory results. Examination of all these issues during the review was aimed at achieving consistency and validity of the research results. The studies that entail high human risks were reviewed within the ethical requirements set for the researches further enhancing validity of the research findings.
Analysis shows that the research findings are consistent with the SE in children. For instance, “data from 20 class III studies found lesions likely detectable with neuroimaging in 7.8% of children, based on a denominator of all available subjects in the studies, thus these data represent an estimate of the minimal yield of these studies” (Riviello et al., 2006, p.1546). Consistent data from twenty studies points to the validity of the current study findings concerning SE in children.
Results of the review suggest that SE in children can be attributed to acute symptomatic cause (in 26 percent of the 2093 patients), remote symptomatic cause (in 33 percent of the patients), febrile SE (in 22 percent), cryptogenic (in 15 percent), progressive encephalopathy (in 3 percent), and remote symptomatic with acute precipitant (in just 1 percent of the patients). More detailed laboratory studies from the review indicate that Na (++), glucose and Ca (++) levels were abnormal in about 6 percent of the patients, which was a routine practice. Conducting blood or spinal fluid culture on the patients showed abnormalities in not less than 2.5 percent and a central nervous system (CNS) infection in not less than 12.8 percent of the patients. Examination of antiepileptic drug (AED) levels in patients on AEDs showed low levels of up to 32 percent. Further analysis revealed a cumulative of 3.6 percent showing evidence of ingestion. Review of studies on inborn errors of metabolism suggested an abnormality in 4.2 percent of the participants. Associated epileptiform abnormalities were found in 43 percent of SE children further helping determine the location and nature of the electroconvulsive events. Finally, the abnormalities used to discern etiology of SE were found in not less than 8 percent of the patients.
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Perceived validity of the review findings and their succinct presentation imply their applicability in nursing practice. Therefore, current research findings can be used for referencing by an advanced practice nurse or registered nurse during their medical practice.
The study was funded by American Academy of Neurology (AAN) and endorsed by American College of Emergency Physicians, American Epilepsy Society, and American Academy of Pediatrics. Funding by AAN and support of such credible organizations suggest the research validity and significance.
Strengths and Limitations of the Review
Current review is based on strong research elements that qualify its applicability. First, the review considers credible academic materials published in the last thirty five years. The inclusion and exclusion criteria ensured that researchers used only credible materials, which proves the validity of research findings. The review is based on strong elements of research with the clear topic and abstract highlighting the main issue of the study, clear research objectives and problem, extensive discussion of the methodology, and coherent presentation of the results and recommendations.
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Despite its strengths, certain sections of the study, such as literature review and discussion of the results are not strongly presented. The study lacks a distinct literature section and a discussion section after the analysis of the evidence. Discussion of the findings would strengthen the issues found in the literature review and further enable a deeper comprehension of the SE in children. Otherwise, the research is very well organized.
Was the Objective Accomplished?
As indicated, the study was set to study existing evidence on the assessment of children with SE, which it clearly presents in the end. Thus, it implies the accomplishment of the research objectives.
Riviello et al. (2006) in their research presented credible information that can be used by a practicing advanced practice or a registered nurse in management of the SE in children. From the study it is clear that SE should be treated immediately and its treatment measures continuously reassessed. Information provided in the review can help APRN and RN terminate seizures by identifying and managing precipitant conditions. Given research, which covers articles published between 1970 and 2005, presents information that is issue-specific and applicable to all nursing practitioners who are interested in working with SE children.