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Procedural sedation in children in the emergency department: a PREDICT study
Meredith Borland1, Amanda Esson, Franz Babl
1Princess Margaret Hospital, Perth, Western Australia, Australia. meredith.borland@health.wa.gov.au
Emergency Medicine Australasia : EMA
|March 4, 2009
Summary
Pediatric emergency departments frequently use nitrous oxide, ketamine, and midazolam for procedural sedation. However, guidelines, documentation, and staff training require improvement for better patient care.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Practice Guidelines
- Procedural Sedation
Background:
- Procedural sedation is common in pediatric emergency departments.
- Current practices and adherence to clinical practice guidelines (CPG) for procedural sedation are not well-defined across research networks.
Purpose of the Study:
- To investigate current procedural sedation practices in the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network.
- To compare existing clinical practice guidelines (CPG) with current procedural sedation practices.
- To identify areas for improvement and establish baseline data for future multicenter studies.
Main Methods:
- A questionnaire was distributed to specialist emergency physicians within the PREDICT network.
- The survey collected data on physician demographics, general procedural sedation practices, and specific sedation agents used in children.
- Clinical practice guidelines (CPG) for general sedation and specific agents were obtained from each participating site.
Main Results:
- Nitrous oxide (N2O), ketamine, and midazolam were the most frequently used agents for procedural sedation.
- Formal sedation records and checklists were utilized by 57% of respondents, while 41% reported auditing sedation practices.
- Nine sites had general sedation CPGs, but no site had a guideline for propofol administration.
Conclusions:
- Procedural sedation in the PREDICT network commonly involves N2O, ketamine, and midazolam for diverse procedures.
- Significant areas for improvement include the development of guidelines for specific agents, enhanced documentation, staff competency training, and auditing.
- Further multicenter research is needed to address gaps in age cut-offs, fasting times, and optimal agent indications.
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