Variation in Pediatric Procedural Sedations Across Children’s Hospital Emergency Departments

Miller, Andrew F.; Monuteaux, Michael C.; Bourgeois, Florence T.; Fleegler, Eric W.

doi:10.1542/hpeds.2017-0045

Cited by 18 publications

(25 citation statements)

References 47 publications

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“…11 Variations of confidence about clinical skills, medical treatment, and satisfaction with their residency training program, 12 which contributes to the quality of pediatric emergency patient care, also raise concerns. 9,10,13,14 Medical malpractice claims could also arise from errors in diagnoses of pediatric emergency care in the ED setting if the first-line practitioner is not familiar with common medical diagnoses. 15,16 The issues of lack of formal curricula or faculty expertise for patient safety and unexpected medical errors for pediatric EM trainees have also been raised.…”

Section: Introductionmentioning

confidence: 99%

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Chen

Chaou

et al. 2020

Hong Kong Journal of Emergency Medicine

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Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.

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Section: Introductionmentioning

confidence: 99%

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Chen

Chaou

et al. 2020

Hong Kong Journal of Emergency Medicine

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“…But documented a significant increase in the use of dexmedetomidine and other intravenously administered sedation medications (i.e., propofol, ketamine, and fentanyl). 12 Although dexmedetomidine may be an effective and safe alternative to chloral hydrate, the practical use of the medication is limited owing to the longer time to achieve the desired effect (20-40 minutes), which makes it less desirable in a busy clinical environment. 3,[9][10][11]13,14 In this study, we defined sedation success as the ability to complete the desired study without the need for an unplanned second (rescue) medication.…”

Section: Discussionmentioning

confidence: 99%

Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

Anderson¹,

Dalabih²,

Birisi³

et al. 2018

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. METHODS Subjects who received pentobarbital were recruited from a prospectively collected database, whereas we used a retrospective chart review to study subjects who received chloral hydrate. Sedation success was defined as the ability to provide adequate sedation using a single medication. We included electively performed sedations for subjects aged 2 months to 3 years who received either pentobarbital or chloral hydrate orally. We excluded subjects stratified as American Academy of Anesthesiologists category III or higher and those who received sedation for electroencephalogram. The data collected captured subject demographics and complications. RESULTS Five hundred thirty-four subjects were included in the final analysis, 368 in the chloral hydrate group and 166 in the pentobarbital group. Subjects who received pentobarbital had a statistically significant higher success rate [136 (82%) vs 238 (65%), p < 0.001], but longer sleeping time (18.1% vs 0%, p < 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the <1 year of age group (6.5% vs 1.8%, p = 0.03). CONCLUSIONS For pediatric patients younger than 3 years of age undergoing sedation for imaging studies, oral pentobarbital may be at least as effective and as safe as chloral hydrate, making it an acceptable and practical alternative.

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“…In addition, children frequently present with ambiguous symptoms and signs that require diagnostic tests. Sedation is therefore often required for the examination and treatment of uncooperative children [1]. Moreover, sedation in the emergency department (ED) is being more frequently administered by emergency department doctors, rather than by anesthesiologists, indicating the need for a safe sedation protocol [2].…”

Section: Introductionmentioning

confidence: 99%

“…However, the type of sedation administered to pediatric patients in the ED has been found to depend on the patient's condition, the situation inside the ED, and the skill and preference of the physician, preventing control of AEs. As a result, different regimens and doses of medications are administered in different facilities and to different patients [1]. At present, therefore, there are few guidelines regarding the safe administration of sedatives, including their regimens and dosage, and interval of drugs, to pediatric patients in the ED.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Pediatric Sedation Protocols for Painless Diagnostic Examination in A Pediatric Emergency Room of A Single Tertiary Hospital

Park

Byun

Lee

et al. 2020

Preprint

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Background: Pediatric patients undergoing diagnostic tests in the pediatric emergency room are frequently sedated. Although efforts are made to prevent adverse events, no sedation protocol has specified the optimal regimen, dosage, and interval of medication to prevent adverse events. This study analyzed the safety and efficacy of sequential pediatric sedation protocols for pediatric patients undergoing diagnostic tests in the pediatric emergency room of a single tertiary medical center.Methods: The medical records of patients aged <18 years who visited the pediatric emergency room of Seoul Asan Medical Center between January and December 2019 for diagnostic testing were retrospectively reviewed. Sedation protocols consisted of 50 and 25 mg/kg chloral hydrate, 0.1 and 0.1 mg/kg midazolam, and 1 and 0.5–1 mg/kg ketamine, administered sequentially at intervals of 30, 20, 10, 10, and 10 min, respectively. Patients were assessed prior to sedation, and adverse events were investigated.Results: Of the 289 included patients, 20 (6.9%) experienced adverse events, none serious, and nine (3.1%) failed to reach the depth of sedation required to complete the test. The regimen (P=0.622) and dosage (P=0.777) of the sedatives were unrelated to the occurrence of adverse events when sedation was performed according to protocol.Conclusion: The sedation protocol used in these patients, consisting of sequential administration of minimum dosages, achieved a sufficient depth of sedation with relatively few adverse events, indicating that this protocol can be used safely and effectively for painless sedation in pediatric patients undergoing diagnostic testing.

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Variation in Pediatric Procedural Sedations Across Children’s Hospital Emergency Departments

Abstract: There is significant variability across pediatric EDs in the use of procedural sedation, suggesting sedations may be performed too often or too little in some hospitals.

Cited by 18 publications

References 47 publications

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

Safety and Efficacy of Pediatric Sedation Protocols for Painless Diagnostic Examination in A Pediatric Emergency Room of A Single Tertiary Hospital

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