Comparison of Procedural Sedation Outcomes in Children With and Without Autism Spectrum Disorder
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Published on: October 4, 2018
Nirupama Kannikeswaran1, Mark G Roback2, Rebecca K Burger3
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Central Michigan University School of Medicine, Detroit, Michigan.
Insights
Children with autism spectrum disorder (ASD) face higher risks for sedation-related airway adverse events (AEs) and respiratory interventions, though critical AEs remain uncommon. This study compared AEs in children with and without ASD.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Disorders
- Patient Safety
Background:
- Children with autism spectrum disorder (ASD) often have comorbidities that increase risks during sedation.
- Sedation-related adverse events (AEs) are a concern in pediatric populations, particularly those with underlying health conditions.
Purpose of the Study:
- To compare the incidence and types of sedation-related AEs in children with and without ASD.
- To identify specific risks associated with sedation in children diagnosed with ASD.
Main Methods:
- A multicenter study analyzed data from the Pediatric Sedation Research Consortium database (May 2022-April 2023).
- Children aged 3-18 years with and without ASD undergoing non-operating room sedation were compared.
- Analysis involved matching participants based on age, sex, procedure, and ASA classification to control for confounding factors.
Main Results:
- Out of 64,708 children, 6.8% had an ASD diagnosis, with higher rates of male sex, obesity, and comorbidities.
- Matched analysis revealed no significant difference in critical AEs (OR, 0.63; 95% CI, 0.23-1.49).
- Children with ASD showed increased odds of high-risk (OR, 1.52; 95% CI, 1.26-1.83) and low-risk AEs (OR, 1.39; 95% CI, 1.25-1.55), including hypoxia and airway obstruction.
Conclusions:
- Children with ASD are at a significantly higher risk for sedation-related airway adverse events.
- Increased odds of hypoxia and airway obstruction (complete and partial) were observed in children with ASD.
- While critical AEs were infrequent, the study highlights the need for careful monitoring and management of respiratory events during sedation in children with ASD.
Objective:
Children with autism spectrum disorder (ASD) often have comorbidities predisposing them to higher risk for sedation-related adverse events (AEs). Our objective was to compare sedation-related AEs in children with and without ASD.
Patients And Methods:
We conducted a multicenter study of children aged 3-18 years with and without ASD who underwent sedation outside the operating room from May 1, 2022, to April 30, 2023, using the Pediatric Sedation Research Consortium database. The primary exposure was ASD diagnosis. We compared AEs in children with and without ASD after matching for age, sex, procedure, and American Society of Anesthesiologists classification.
Results:
Of 64 708 children analyzed, 4421 (6.8%) had an ASD diagnosis. A higher proportion of children with ASD were male (75.4% vs 54.7%), obese (6.0% vs 2.9%), and had a comorbid condition (93.5% vs 40.3%). Matched analysis showed no significant difference in critical AEs (odds ratio [OR], 0.63; 95% CI, 0.23-1.49). However, children with ASD had greater odds of high risk (OR, 1.52; 95% CI, 1.26-1.83) and low-risk AEs (OR, 1.39; 95% CI, 1.25-1.55) compared with children without ASD. Specifically, children with ASD had greater odds of hypoxia (OR, 1.31; 95% CI, 1.10-1.56) and complete (OR, 1.89; 95% CI, 1.27-2.81) or partial (OR, 1.43; 95% CI, 1.25-1.63) airway obstruction.
Conclusions:
Children with ASD are at a higher risk for sedation-related airway AEs and significant respiratory interventions, although the incidence of critical AEs was low.
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