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Published on: December 6, 2016
Impact of provider specialty on pediatric procedural sedation complication rates
Kevin G Couloures1, Michael Beach, Joseph P Cravero
1Department of Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
Insights
Medical specialty does not impact major complication rates in pediatric procedural sedation. This study found no significant differences among various pediatric specialists providing sedation services.
Area of Science:
- Pediatric Anesthesiology
- Sedation Management
- Patient Safety
Background:
- Pediatric procedural sedation is commonly performed by various medical specialists.
- Understanding potential variations in patient safety outcomes based on provider specialty is crucial for optimizing care.
- Organized sedation services aim to standardize and improve the safety of procedural sedation.
Purpose of the Study:
- To investigate whether the medical specialty of the sedation provider influences the rate of major complications in pediatric procedural sedation.
- To compare complication rates across different pediatric specialist groups within an organized sedation service framework.
Main Methods:
- Prospective data collection from 38 members of the Pediatric Sedation Research Consortium involving 131,751 cases.
- Major complications were defined and tracked, including aspiration, death, cardiac arrest, and unplanned hospital admissions.
- Statistical analysis compared complication rates per 10,000 sedations across provider specialties (anesthesiologists, emergency medicine, intensivists, pediatricians, other), adjusting for confounding variables.
Main Results:
- A total of 122 major complications occurred in 131,751 pediatric procedural sedation cases; no deaths were reported.
- Complication rates per 10,000 sedations varied slightly by specialty but showed no statistically significant differences (e.g., anesthesiologists: 7.6, pediatricians: 12.4).
- Adjusted and unadjusted analyses revealed no significant differences in major complication rates among the different pediatric medical specialties.
Conclusions:
- Pediatric procedural sedation administered by various specialists within an organized sedation service is associated with a low risk of serious adverse outcomes.
- Provider medical specialty does not appear to be a significant factor in major complication rates for pediatric procedural sedation outside the operating room.
Objective:
To determine if pediatric procedural sedation-provider medical specialty affects major complication rates when sedation-providers are part of an organized sedation service.
Methods:
The 38 self-selected members of the Pediatric Sedation Research Consortium prospectively collected data under institutional review board approval. Demographic data, primary and coexisting illness, procedure, medications used, outcomes, airway interventions, provider specialty, and adverse events were reported on a self-audited, Web-based data collection tool. Major complications were defined as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesia consultation. Event rates per 10 000 sedations, 95% confidence intervals, and odds ratios were calculated using anesthesiologists as the reference group and were then adjusted for age, emergency status, American Society of Anesthesiologists physical status > 2, nil per os for solids, propofol use, and clustering by site.
Results:
Between July 1, 2004, and December 31, 2008, 131 751 pediatric procedural sedation cases were recorded; there were 122 major complications and no deaths. Major complication rates and 95% confidence intervals per 10 000 sedations were as follows: anesthesiologists, 7.6 (4.6-12.8); emergency medicine, 7.8 (5.5-11.2); intensivist, 9.6 (7.3-12.6); pediatrician, 12.4 (6.9-20.4); and other, 10.2 (5.1-18.3). There was no statistical difference (P > .05) among provider's complication rates before or after adjustment for potential confounding variables.
Conclusions:
In our sedation services consortium, pediatric procedural sedation performed outside the operating room is unlikely to yield serious adverse outcomes. Within this framework, no differences were evident in either the adjusted or unadjusted rates of major complications among different pediatric specialists.
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