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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.
Summary
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.