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Variations in sedating uncooperative, stable children for post-traumatic head CT
G P Conners1, W K Sacks, N F Leahey
1Department of Emergency Medicine, University of Rochester Medical Center, New York 14642, USA.
Insights
Pediatric emergency physicians show wide variation in how they sedate children for head CT scans. This includes differences in training, guideline adherence, and chosen sedation methods, leading to dissatisfaction.
Area of Science:
- Pediatric Emergency Medicine
- Medical Imaging Sedation
- Clinical Practice Variation
Background:
- Sedation is often required for pediatric head CT scans in stable, uncooperative children with head injuries.
- Variations in sedation practices can impact patient safety and care quality.
Purpose of the Study:
- To investigate and characterize the diversity in sedation practices among pediatric emergency physicians and their institutions for head CT.
- To identify factors contributing to variations and physician dissatisfaction with sedation protocols.
Main Methods:
- A mail survey was distributed to members of the Emergency Medicine Section of the American Academy of Pediatrics (AAP).
- Two follow-up mailings were conducted to maximize response rates.
- Usable responses from 304 physicians were analyzed, representing over 17,500 pediatric sedation cases annually.
Main Results:
- 73% of physicians reported formal training in pediatric sedation for head CT.
- 74% followed published sedation guidelines, while 10% were unaware of them.
- Significant variation existed in drug choice (midazolam most common) and over 20 different sedation strategies were used per scenario.
- 26% of respondents expressed dissatisfaction with their sedation practices.
Conclusions:
- Sedation practices for pediatric head CT are highly variable among physicians and institutions.
- Discrepancies in policies and practices may stem from uncertainty regarding optimal sedation strategies.
- Further research into cost-effectiveness and standardization of sedation protocols is recommended.
Objective:
To characterize variations among pediatric emergency physicians and their hospital facilities regarding sedation of the uncooperative, stable child for head CT following closed head injury.
Design:
Mail survey with two follow-up mailings.
Participants:
Surveys were sent to all members of the Emergency Medicine Section of the American Academy of Pediatrics (AAP).
Results:
Of 596 surveys sent, 431 (72%) were returned, with 304 (51%) usable responses. Respondents annually sedate over 17,500 children for post-traumatic head CT. Formal training to sedate children for head CT was noted by 73%. Published guidelines for sedation are followed by 74%; 10% were unaware of the existence of published guidelines for sedation. Twenty-six percent of the respondents were very or somewhat dissatisfied with their sedation-related practices. In response to three clinical scenarios involving sedation of 8-month-old, 3-year-old, and 6-year-old children for head CT, midazolam was the most commonly chosen drug. Over 20 different sedation strategies were selected for each scenario.
Conclusions:
Sedation practices for post-traumatic pediatric head CT vary widely, among both physicians and individual practitioners. Institutional and individual sedation-relation policies vary widely as well. Variation and dissatisfaction with sedation practices may reflect uncertainty regarding optimal sedation strategies. Further cost-effectiveness research is necessary.
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