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Risks to children from computed tomographic scan premedication
Insights
Serious adverse reactions, including life-threatening events, occurred in 13% of children receiving premedication for computed tomographic (CT) head scans. High doses or multiple medications increased reaction risk, especially in infants.
Area of Science:
- Pediatric pharmacology
- Radiology and imaging
Background:
- Premedication is common for computed tomographic (CT) scans in children.
- Adverse reactions to premedication can be serious, necessitating surveillance.
Purpose of the Study:
- To determine the rates and risk factors for adverse reactions in hospitalized children undergoing CT head scans.
- To identify specific patient or medication factors associated with increased risk.
Main Methods:
- Intensive drug surveillance program monitored 106 hospitalized children.
- Data collected on premedication drugs, dosages, and observed adverse events.
- Statistical analysis to identify risk factors for reactions.
Main Results:
- 13% of patients experienced adverse reactions.
- Four life-threatening cardiorespiratory events occurred with narcotic premedication.
- Higher doses (RR 5.2) and multiple medications (RR 3.7) elevated risk.
- All severe reactions were in infants under 3 months; two with morphine sulfate.
Conclusions:
- Physicians must consider the risks of premedication adverse reactions in pediatric CT scans.
- Infants are particularly vulnerable to severe reactions, even with recommended doses.
- Drug surveillance is crucial for understanding and mitigating risks in pediatric imaging.
Abstract:
We observed serious adverse reactions after premedication for computed tomographic (CT) head scans and therefore determined rates and risk factors for such reactions among 106 hospitalized children monitored by an intensive drug surveillance program. Reactions occurred in 13 patients (13%), including four cases of life-threatening cardiorespiratory depression or arrest after narcotic premedication. Other reactions included CNS depression, behavior changes, voiding problems, and vomiting. The risk of reaction was elevated in subjects who received high doses of a premedication drug (relative risk, 5.2) and in those who received four or more premedication (relative risk, 3.7). All life-threatening reactions occurred among infants younger than 3 months, and two of these followed medication with only morphine sulfate, in the recommended dose. Risks of adverse reactions from premedication should be considered by physicians who order CT scans for hospitalized children.