Trends and patterns in the practice of pediatric sedation for magnetic resonance imaging in Japan: A longitudinal descriptive study from 2012 to 2019

Abstract

Background: Worldwide, pediatric sedation for magnetic resonance imaging is a standard practice; however, there are few studies on its trends and patterns. Aims: This study aimed to investigate the trends and patterns of pediatric sedation for magnetic resonance imaging in Japan and determine the incidence of and risk factors for adverse events/interventions. Methods: This longitudinal descriptive study assessed children (age < 15 years) who underwent sedation for magnetic resonance imaging between April 2012 and December 2019 in Japan using a nationwide claims database. We assessed the patients' demographic characteristics, time trends in sedatives, sedative patterns by age, and adverse events/interventions within two post-sedation days. Further, we used multivariable logistic regression models to explore factors related to the incidence of adverse events/interventions. Results:We identified 29 187 cases (median age, 2.0 years; 55.2% males). The most common sedative was triclofos sodium (n = 18 812, 51.7%). There was an increasing trend in barbiturate use (17.0% [2012] to 25.0% [2019]) and decreasing trends in the use of triclofos sodium (56.4% [2012] to 47.7% [2019]) and chloral hydrate (15.6%[2012] to 10.8% [2019]). We identified 534 adverse events/interventions in 460 cases (1.5%). Multivariable logistic regression analyses revealed that the incidence of adverse events/interventions mainly increased with the number of sedatives (≥3; adjusted odds ratio, 5.10; 95% confidence interval, 3.67-7.10) and unscheduled setting (adjusted odds ratio, 6.28; 95% confidence interval, 4.85-8.61); further, it decreased with high hospital procedure volume (adjusted odds ratio, 0.62; 95% confidence interval, 0.49-0.78). Conclusions:Based on a Japanese real-world setting, there is an increasing trend in barbiturate use and decreasing trends in the use of triclofos sodium and chloral hydrate in pediatric sedation for magnetic resonance imaging. Low hospital procedure volumes were associated with an increased risk of adverse events/interventions.

Low billing rates for pediatric sedation fee on magnetic resonance imaging

“…The same trend was observed in inpatient care (where resources are usually more abundant than in outpatient care), although the rate of addition was higher than in outpatient care. This calculation rate is significantly lower than the actual 8‐year calculation of pediatric MRI sedation in the previous report, although a direct comparison is difficult to perform 12 …”

“…This calculation rate is significantly lower than the actual 8-year calculation of pediatric MRI sedation in the previous report, although a direct comparison is difficult to perform. 12 Two physicians with expertise in pediatric MRI sedation as well in performing imaging of two body areas at the same time are required before the additional fee can be calculated. 6 However, in practice, due to a shortage of anesthesiologists, the majority of MRI sedation is performed by pediatricians rather than anesthesiologists, 5 and it takes much effort to secure even one physician dedicated to this task.…”

Anesthesia for pediatric magnetic resonance imaging: a review of practices and current pathways

“…A recent retrospective longitudinal study done in Japan evaluated a 7-year nationwide claims database of patients less than 15 years old undergoing sedated MRI and not receiving inhalational anesthetics and opioids [32]. It must be noted that in Japan propofol can be used only by anesthesiologists and is off-label outside the operating room, thus 85% of sedations were carried out with midazolam, triclofos sodium, chloral hydrate or barbiturates [32]. Adverse events were infrequent (< 2%) and severe complications (e.g., cardiac arrest, need of intubation) rare (< 0.3%).…”

Daytime Variation of Chloral Hydrate-Associated Sedation Outcomes: A Propensity-Matched Cohort Study

“…In many countries, chloral hydrate is no longer available unless specially compounded. However, it is also used in developing countries such as China [3] and Turkey [4], as well as in some developed countries (South Korea [5], Japan [6], Spain [7], and Canada [8]). However, concerns over the use of chloral hydrate have increased due to serious adverse events [9], while other authors still support the use of chloral hydrate for sedation outside the operating room [7,10], especially for non-anesthesiologist-led sedation.…”