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Pediatric Sedation in the Emergency Department: Trends from a Nationwide Population-based Study in Korea, 2007-2018
Jeong Yong Lee1, Seung Jun Choi1, Jun Sung Park1
1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Pediatric emergency department (ED) sedation in Korea shows changing trends. Ketamine use increased significantly, becoming the most common sedative, while chloral hydrate use decreased.
Area of Science:
- Emergency Medicine
- Pediatric Sedation
- Health Services Research
Background:
- Pediatric sedation in emergency departments (EDs) is common in Korea.
- Understanding trends in pediatric sedation is crucial for improving care.
Purpose of the Study:
- To investigate patient characteristics and sedative use in Korean EDs.
- To analyze changes in pediatric sedation trends over time.
Main Methods:
- Nationwide population-based retrospective study (2007-2018).
- Utilized Korean Health Insurance Review and Assessment Service database.
- Analyzed pediatric patients (≤15 years) receiving sedation in EDs.
Main Results:
- Over 468,000 sedation visits recorded.
- Most sedations (71.0%) were for children aged 1-3 years, primarily for injury diagnosis (93.5%).
- Significant shift from chloral hydrate (70.6% to 28.6%) to ketamine (23.8% to 60.7%) use; ketamine became dominant by 2014.
- Age-specific sedative preferences observed: chloral hydrate (<1, 1-3 yrs), ketamine (4-10 yrs), midazolam (11-15 yrs).
Conclusions:
- Patient characteristics and sedative preferences in pediatric ED sedation have evolved.
- These trends necessitate consideration for future Korean guidelines on pediatric ED sedation.
Background:
Pediatric sedation in the emergency department (ED) is widely performed in Korea; thus exploring the trends of its use is necessary. This study aimed to investigate the characteristics of patients and sedatives use in the ED and verify their changes over recent years.
Methods:
A nationwide population-based retrospective study was conducted including pediatric patients aged ≤ 15 years who received sedative medication in the ED and were discharged during 2007-2018, using the Korean Health Insurance Review and Assessment Service database. Patient characteristics (age, sex, level of ED, and diagnosis) and type of sedative used were analyzed.
Results:
Sedation was performed in total 468,221 visits during 2007-2018 (399,320 visits, at least 3.8% of overall ED visits during 2009-2018). Among these, 71.0% were children aged 1-3 years and 93.5% were sedated to support diagnosis of injury. An increase in total sedation was observed in patients aged 4-6 years during the study period (from 13.8% to 21.8%). A gradual decrease in the use of chloral hydrate (CH) compared with an increase in ketamine use was observed (CH, from 70.6% to 28.6%; ketamine, from 23.8% to 60.7%). Therefore, ketamine was the most used sedative since 2014. The most frequently used sedatives over the study period differed according to age groups (CH in <1 year and 1-3 years; ketamine in 4-6 years and 7-10 years; and midazolam in 11-15 years).
Conclusions:
The characteristics of patients related to sedatives use in the ED have changed over time. These changes should be considered in the development of future Korean guidelines regarding pediatric sedation in the ED.
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