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Behavioral Changes in Children After Emergency Department Procedural Sedation
Jean I Pearce1, David C Brousseau1,2, Ke Yan1,3
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Insights
Nearly 40% of children sedated for fractures in the emergency department (ED) show high anxiety before procedures. Almost a quarter experience negative behaviors post-discharge, with high anxiety and nonwhite race as key predictors.
Area of Science:
- Pediatric Emergency Medicine
- Child Psychology
- Sedation Anesthesia
Background:
- Procedural sedation is common in emergency departments (EDs) for pediatric fracture reduction.
- Post-discharge behavioral changes in children following sedation are not well-understood.
- Anxiety is a potential factor influencing post-procedural behavior.
Purpose of the Study:
- To determine the proportion of children experiencing negative post-discharge behaviors after procedural sedation for fracture reduction in the ED.
- To identify predictors of these negative behaviors, including pre-sedation anxiety.
Main Methods:
- Prospective cohort study of children receiving ketamine sedation for fracture reduction.
- Anxiety measured using the Modified Yale Preoperative Anxiety Scale.
- Negative behaviors assessed via the Post-Hospitalization Behavior Questionnaire 1-2 weeks post-discharge.
Main Results:
- 85% of 97 enrolled children completed follow-up.
- 40% exhibited high pre-sedation anxiety; 22% showed significant negative behaviors post-discharge.
- High anxiety (OR=9.0) and nonwhite race (OR=6.5) were independent predictors of negative behaviors.
Conclusions:
- Two in five children undergoing procedural sedation in the ED experience high pre-procedure anxiety.
- Nearly one in four children exhibit significant negative behaviors 1-2 weeks after ED discharge.
- Highly anxious and nonwhite children face an elevated risk of negative behavioral changes, a previously unrecognized issue in the ED.
Objective:
The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative postdischarge behaviors. Predictors of negative behaviors were evaluated, including anxiety.
Methods:
This was a prospective cohort study of children receiving intravenous ketamine sedation for ED fracture reduction. The child's anxiety prior to sedation was measured with the Modified Yale Preoperative Anxiety Scale. Negative behavioral changes were measured with the Post-Hospitalization Behavior Questionnaire 1 to 2 weeks after discharge. Descriptive statistics and odds ratios (ORs) were calculated. Chi-square test was used for comparisons between groups. Multivariable logistic regression models evaluated predictors of negative behavioral change after discharge.
Results:
Ninety-seven patients were enrolled; 82 (85%) completed follow-up. Overall, 33 (40%) children were observed to be highly anxious presedation and 18 (22%) had significant negative behavior changes after ED discharge. Independent predictors for negative behaviors were high anxiety (OR = 9.0, 95% confidence interval [CI] = 2.3-35.7) and nonwhite race (OR = 6.5, 95% CI = 1.7-25.0).
Conclusion:
For children undergoing procedural sedation in the ED, two in five children have high preprocedure anxiety and almost one in four have significant negative behaviors 1 to 2 weeks after discharge. Highly anxious and nonwhite children have increased risk of negative behavioral changes that have not been previously recognized in the ED setting.