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Published on: July 30, 2009
Sedation/anesthesia use for inpatient pediatric brain MRIs: National trends and outcomes
Kristen H Calhoun1, Matthew Hall2, Stephanie Arar1
1Division of Pediatric Hospital Medicine and Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health Dallas, UT Southwestern Medical Center, Dallas, Texas, USA.
Background:
Minimizing unnecessary sedation/anesthesia for pediatric brain MRI has been identified as an area for improvement. However, data on its use across a national sample of children's hospitals is lacking.
Objective:
To understand patient demographics, clinical outcomes, hospital variation, and trends over time associated with sedation/anesthesia use for pediatric brain MRIs.
Methods:
This retrospective cohort study utilized Pediatric Health Information System (PHIS) data for children < 18 years old who received an inpatient brain MRI from 2014 to 2024 (N = 215,377). Outcomes included the need for a repeat brain MRI, length of stay (LOS, in days), cost, and mortality. The likelihood of receiving sedation/anesthesia was modeled using Generalized Estimating Equations (GEE), clustered on hospital and adjusted for clinical and demographic factors. Outcomes were also modeled using GEEs.
Results:
Sedation/anesthesia was used for 36% of children with no significant change over time. There was significant hospital variation in sedation/anesthesia use, ranging from 4.8% to 54.9%. Age, mental health diagnoses, and MRI type (contrast, limited) were associated with the likelihood of receiving sedation/anesthesia. Compared to no sedation/anesthesia, sedation/anesthesia use was associated with a lower likelihood of repeat MRI (1.7% vs. 5.6%, aOR 0.29, 95% CI: 0.25-0.34) and higher cost ($12,819 vs. $10,122, aRR 1.27, 95% CI: 1.13-1.42). There were no meaningful differences in LOS or mortality.
Conclusion:
There is currently wide variability in the use of sedation/anesthesia across children's hospitals, and its use was associated with lower repeat MRIs but higher costs. Identification of appropriate patients and MRI techniques may be strategies to reduce unnecessary sedation/anesthesia.
