Reducing Sedation for Pediatric Thoracic CT Imaging Using Volumetric Target-mode EKG Gating.

Area of Science:

• Pediatric radiology
• Medical imaging technology
• Patient safety in medical procedures

Background:

• Sedation is frequently required for pediatric thoracic (chest and cardiac) computed tomography (CT) scans.
• High sedation rates pose challenges for young children undergoing these essential imaging procedures.

Purpose of the Study:

• To decrease the rate of sedation for thoracic CT scans in children aged 0-4 years.
• To implement and sustain a reduction in sedation from a baseline of 65% to a target of 20%.

Main Methods:

• Developed a new volumetric target-mode electrocardiogram-gated CT imaging protocol to shorten scan times.
• Implemented staff training, improved communication, and removed default sedation orders for thoracic CT scans.
• Utilized statistical process control charts to monitor changes over time.

Main Results:

• Sedation rates for pediatric thoracic CT scans decreased from 65% (232/357) at baseline to 24% (217/794) during the intervention period.
• The reduction in sedation was sustained five years post-intervention.
• The rate of initially nondiagnostic nonsedated scans requiring repeat sedation was very low (0.1% to 0.4%).

Conclusions:

• A combination of a novel CT imaging protocol and revised ordering practices effectively reduced sedation in young children.
• The implemented changes, including a volumetric target-mode electrocardiogram-gated CT protocol and elimination of default sedation orders, proved sustainable.
• This approach enhances the safety and efficiency of thoracic CT scans for pediatric patients.