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The impact of procedural sedation on diagnostic errors in pediatric echocardiography
Kenan W D Stern1, Kimberlee Gauvreau1, Tal Geva1
1Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Insights
Sedation significantly improves echocardiographic study quality in young children by reducing diagnostic errors and image concerns. This finding supports the use of sedation for pediatric echocardiography to enhance diagnostic accuracy.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Infants and young children often struggle to remain still during echocardiography, impacting study quality and potentially leading to diagnostic errors.
- While sedation is thought to improve echocardiographic quality, its effectiveness in reducing errors has not been definitively proven.
Purpose of the Study:
- To test the hypothesis that sedation improves echocardiographic study quality in pediatric patients.
- To determine if sedation reduces diagnostic errors in echocardiograms of infants and young children.
Main Methods:
- Analysis of 2,003 outpatient echocardiograms from children aged 36 months or younger.
- Collection of data on image quality, report completeness, and sedation use.
- Multivariate analysis to identify risk factors for diagnostic errors and the impact of sedation.
Main Results:
- Sedation was used in 25% of examinations; the overall diagnostic error rate was 6.5%, with 66% being potentially preventable.
- Sedation was independently associated with lower odds of potentially preventable diagnostic errors (OR, 0.47; 95% CI, 0.27-0.80).
- Echocardiograms with sedation showed fewer image quality concerns (22% vs. 60%) and incomplete reports (3% vs. 20%) compared to non-sedated studies (P < .001).
Conclusions:
- The majority of diagnostic errors in pediatric echocardiography are potentially preventable.
- Sedation is linked to a reduced likelihood of diagnostic errors, improved imaging quality, and more complete reports in young children.
Background:
Infants and young children frequently have difficulty remaining still for an echocardiographic examination, potentially leading to poor study quality, increasing the likelihood of diagnostic errors. Sedation is believed to improve echocardiographic quality, but its effectiveness has not been demonstrated. The aim of this study was to test the hypothesis that sedation would improve study quality and reduce diagnostic errors.
Methods:
Outpatient echocardiograms from children aged ≤36 months obtained from January 2008 to June 2009 were examined. Variables related to image quality, report completeness, and sedation use were collected. Diagnostic errors were identified and categorized. Multivariate analysis identified the odds ratios (OR) and 95% confidence intervals (CI) for risk factors for potentially preventable diagnostic errors and the impact of sedation on these errors.
Results:
Among 2,003 echocardiographic examinations, sedation was used in 498 (25%). The overall diagnostic error rate was 6.5%. Most errors (66%) were potentially preventable. Multivariate analysis identified the following risk factors for potentially preventable errors: precardiac procedure (OR, 2.19; 95% CI, 1.05-4.59; P = .04), moderate anatomic complexity (OR, 3.91; 95% CI, 2.25-6.81; P < .001), and high anatomic complexity (OR, 8.36; 95% CI, 3.57-19.6; P < .001). Sedation was independently associated with lower odds of potentially preventable diagnostic errors (OR, 0.47; 95% CI, 0.27-0.80; P = .006). Echocardiographic examinations with sedation had fewer image quality concerns (22% vs 60%) and fewer incomplete reports (3% vs 20%) (P < .001).
Conclusions:
Most echocardiographic diagnostic errors among infants and young children are potentially preventable. Sedation is associated with a lower likelihood of these diagnostic errors, fewer imaging quality concerns, and fewer incomplete reports.
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