Prehospital Ketamine Use in Pediatrics

Area of Science:

• Emergency Medicine
• Pediatric Care
• Pharmacology

Background:

• Limited data exists on prehospital ketamine use in pediatric patients.
• Existing literature primarily focuses on critical care and air transport settings.

Purpose of the Study:

• To describe patient characteristics of pediatric emergency medical services (EMS) patients receiving ketamine.
• To assess the effectiveness, dosing deviations, and adverse outcomes of prehospital ketamine administration in children.

Main Methods:

• Retrospective review of 2019-2020 ESO Data Collaborative records for pediatric patients (≤18 years) receiving ketamine.
• Analysis of patient demographics, EMS impressions, medication administration, effectiveness (clinical improvement, pain score reduction), and adverse events.

Main Results:

• 1,291 pediatric patients received ketamine; predominantly males, teenagers, Caucasian, and from urban areas.
• Ketamine was most commonly indicated for injuries (62.7%) and behavioral disorders (21.8%).
• EMS clinicians reported improvement in 89.1% of patients; significant pain score reduction (≥2 points) in 59% of injured patients, with minimal desaturation events (1.8%).

Conclusions:

• Prehospital ketamine in pediatric patients is frequently used for analgesia and other indications, with a high rate of observed improvement.
• Few significant adverse events were documented, suggesting ketamine is relatively safe for pediatric prehospital use.
• This study provides valuable insights into the characteristics, effectiveness, and safety of ketamine in a large pediatric EMS population.