Variation in Pediatric Procedural Sedations Across Children's Hospital Emergency Departments

Area of Science:

• Pediatric Emergency Medicine
• Pharmacology
• Health Services Research

Background:

• Procedural sedation is common in pediatric emergency departments (EDs).
• Understanding trends and variations in sedation use is crucial for optimizing patient care and resource allocation.
• Existing data on sedation practices across diverse pediatric EDs is limited.

Purpose of the Study:

• To describe trends in pediatric procedural sedation use over time (2009-2014).
• To determine variations in procedural sedation utilization across children's hospital emergency departments.
• To identify shifts in specific sedative medication preferences.

Main Methods:

• Analysis of emergency department data from 35 children's hospitals (2009-2014).
• Inclusion of patients under 19 years old receiving sedation and discharged.
• Exclusion of patients with chronic comorbidities or undergoing intubation.
• Descriptive statistics with appropriate weighting to assess frequency, trends, and inter-hospital variation.

Main Results:

• Approximately 7.9% of eligible patients (99,951 out of 1,448,011) received procedural sedation.
• In 2014, ketamine was most common (73.7%), followed by fentanyl/midazolam (15.9%), ketofol (7.3%), and propofol (2.7%).
• Fentanyl/midazolam use increased, while ketamine and other agents decreased over time.
• Significant variation in sedation rates observed across hospitals (0.2% to 32.0% in 2014).
• Dislocation treatment showed the largest variation in sedation use (2% to 35%).

Conclusions:

• Substantial variability exists in procedural sedation practices among pediatric emergency departments.
• These variations suggest potential inconsistencies in sedation administration, possibly indicating overuse or underuse in certain settings.
• Further research is needed to establish evidence-based guidelines and standardize sedation practices in pediatric EDs.