Paediatric Procedural Sedation and Analgesia in Emergency Departments: A Delphi Consensus Study

To develop a national expert consensus on procedural sedation and analgesia practices in paediatric emergency departments in Spain and identify priority areas for standardisation, safety and implementation.

We conducted a modified two-round Delphi study with a panel of 28 clinicians with expertise in paediatric emergency care and procedural sedation from 23 centres in different regions of Spain. Participants rated key domains related to patient selection, fasting, monitoring, staffing, pharmacological strategies, training and safety standards. We used a predefined threshold of ≥ 70% agreement to establish consensus in both rounds.

The panel reached strong consensus across core domains of paediatric procedural sedation practice, including minimum safety requirements, monitoring standards, staff competencies and organisational priorities. Strong agreement supported the standardisation of procedural sedation processes. Areas of residual disagreement highlighted persistent variation in implementation and resource availability across departments. Pharmacological preferences differed according to the clinical scenario; ketamine was preferred for more painful procedures, but drug preferences for less invasive procedures or imaging procedures varied.

This national Delphi consensus provides a pragmatic framework to support safer and more consistent procedural sedation practice in paediatric emergency departments. Although the study included only centres in Spain, it addressed operational and clinical challenges common worldwide, and its findings are likely relevant for all emergency departments seeking to improve paediatric sedation.