Unplanned Repeat Echocardiography with Sedation in Children: Patient Risk Factors
Kenan W D Stern1,2, Chen Chen3,4, Hillel W Cohen5
1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA. kstern@montefiore.org.
Insights
Identifying predictors for repeat pediatric echocardiography with sedation is crucial. Older age, complex cardiac conditions like Kawasaki disease, and higher anatomic complexity increase the need for repeat procedures, while murmurs indicate fewer repeat scans.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
Background:
- Sedation is often required for pediatric echocardiography, but criteria for its use, especially for repeat procedures, are not well-defined.
- Unplanned repeat echocardiography with sedation in children can increase healthcare costs and patient burden.
Purpose of the Study:
- To identify predictors of unplanned repeat echocardiography with sedation in pediatric patients.
- To inform the development of better patient selection criteria for sedation in pediatric echocardiography.
Main Methods:
- A single-center, case-control study was conducted on children aged 1-36 months who underwent echocardiography.
- Cases had unplanned repeat echocardiograms with sedation; controls did not.
- Logistic regression analysis was used to identify significant predictors of repeat procedures.
Main Results:
- Older age (6 months to <2 years), presence of structural cardiac disease, higher anatomic complexity (≥moderate), and a history of Kawasaki disease were significant risk factors for repeat echocardiography with sedation.
- Children with known moderate or greater anatomic complexity pre-echocardiogram had higher odds of repeat scans.
- An indication for a murmur was found to be a protective factor, associated with fewer repeat procedures.
Conclusions:
- Age, cardiac anatomic complexity, and specific conditions like Kawasaki disease are key predictors for repeat pediatric echocardiography requiring sedation.
- The presence of a murmur may suggest a lower likelihood of needing repeat sedated echocardiograms.
- These findings can aid pediatric echocardiography labs in refining sedation protocols and patient selection.
Abstract:
Patient selection criteria for echocardiography with sedation in children are not well defined. We attempted to identify predictors of unplanned repeat echocardiography with sedation. This was a single-center, case-control study of echocardiograms performed in children aged 1-36 months. Cases underwent unplanned repeat examinations with sedation, while controls did not. Patient variables and study indications were compared. Logistic regression identified the most significant predictors. Cases (n = 104, median time to repeat echocardiogram 17 days, median age 12.9 months) were older than controls (n = 212, median age 5.0 months, P < 0.001). Significantly more cases than controls had structural cardiac disease (64 vs. 23 %) and anatomic complexity ≥moderate (38 vs. 5 %, P < 0.001 for both). Cases more often had Kawasaki disease (11 vs. 2 %), and controls more often had murmur (56 vs. 11 %, P < 0.001 for both). Logistic regression identified age 6 months to <2 years (OR 3.26, 95 % CI 1.70-6.28, P < 0.001), Kawasaki disease (OR 5.20, 95 % CI 1.46-18.50, P = 0.01), and known pre-echocardiogram anatomic complexity ≥moderate (OR 3.99, 95 % CI 1.64-9.66, P = 0.002) as significant risk factors. An indication for murmur was protective (OR 0.32, 95 % CI 0.13-0.76, P = 0.01). We identified several risk factors for unplanned repeat echocardiography with sedation in children, including age 6 months to <2 years, higher anatomic complexity, and Kawasaki disease. Murmur was a protective factor. These results may help pediatric echocardiography laboratories establish criteria for sedation.
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