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Adapting Perioperative Care for Neurodivergent Children - A Scoping Review
Spandana Veeravalli1, Maia Michaud2, Judy Colton3
1Department of Surgical and Interventional Sciences, McGill University Faculty of Medicine and Health Sciences, Montreal, QC, Canada.
Insights
This study addresses the need for better perioperative care for neurodivergent children by reviewing interventions and developing a checklist. Personalized care plans, sedation adjustments, and mobility aids are key themes for improving their healthcare experience.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Disorders
- Healthcare Quality Improvement
Background:
- Neurodivergent children face unique challenges during routine procedures, necessitating specialized perioperative care.
- A lack of evidence-based guidelines complicates care for healthcare professionals unfamiliar with diverse neurodevelopmental conditions.
Purpose of the Study:
- To review existing interventions for neurodivergent children undergoing perioperative procedures.
- To identify key themes in adapting care for this population.
- To develop a practical checklist to support healthcare providers.
Main Methods:
- A comprehensive scoping review following PRISMA-ScR guidelines, searching 8 databases until May 2023.
- Inclusion criteria focused on pediatric neurodivergent populations, perioperative interventions, and original research.
- Patient partners' perspectives were integrated into data analysis and interpretation.
Main Results:
- Analysis of 29 studies revealed three primary themes: individualized care plans (27.6%), modulated pre-procedural sedation (17.2%), and innovative mobility devices (10.3%).
- Effective care plans involve caregiver collaboration, patient preferences, trigger identification, and communication strategies.
- A multidisciplinary approach, including child life specialists, is crucial, featuring in 62.5% of care plan studies.
Conclusions:
- Optimizing perioperative care for neurodivergent children requires a thorough assessment of individual needs.
- Personalized care plans, incorporating tailored pharmacological and non-pharmacological interventions, are essential for improved outcomes.
Purpose:
Routine procedures often pose heightened challenges for neurodivergent children, resulting in increased need for perioperative care compared to the general population. Healthcare professionals' reduced familiarity with infrequent neurodivergent diagnoses further underscores the necessity of evidence-based guidelines. As no guidelines currently exist, our study aims to review interventions, delineate key themes, and develop a checklist to aid healthcare professionals in navigating the perioperative process for neurodivergent patients.
Methods:
Following PRISMA-ScR guidelines, we searched 8 databases from inception until May 2023 for studies assessing perioperative interventions for neurodivergent children. Articles were included if they: (1) focused on the pediatric neurodivergent population, (2) evaluated an intervention that adapted perioperative care, and (3) represented an original research study. To increase the study's inclusiveness, patient partners' perspectives were incorporated into data analysis and interpretation.
Results:
Out of 7992 articles screened at title and abstract level, 144 were reviewed in full-text format and 29 included in the analysis. Three key themes were identified: use of individualized care plans (27.6 % of included articles), modulation of pre-procedural sedation (17.2 %), and use of innovative mobility devices to improve safety of patient transfers (10.3 %). Care plans were created in collaboration with caregivers, assessing patients' preferences, triggers, and communication style. A multidisciplinary therapeutic approach was deemed crucial, including child life specialists - mentioned in 62.5 % of care plans studies.
Conclusion:
Improving perioperative care for neurodivergent children centers on the evaluation of their individual needs, followed by designing personalized care plans which include tailored pharmacological and non-pharmacological interventions.
Level Of Evidence:
III (scoping review, with lowest level of evidence included being case-control study).
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