320 - Rates and Predictors of Procedural Sedation for Head and Neck CT and MRI in the Pediatric Emergency Department

Although advanced diagnostic imaging is often performed among children evaluated in the emergency department (ED), little is known about how often children require procedural sedation for these imaging studies.

Objective:

To describe variability in rates of procedural sedation for computed tomography (CT) and magnetic resonance imaging (MRI) of the head and neck in pediatric ED’s, and to describe the factors associated with sedation for these imaging studies.

Design/Methods:

We conducted a retrospective cross-sectional study using the Pediatric Health Information System of children < 18 years old who were evaluated in a pediatric ED between 2012 and 2021 with an isolated CT or MRI of the head or neck. Patients were excluded if they were admitted to the operating room or intensive care unit, received a neuromuscular blockade agent, or died. We defined procedural sedation for imaging as receiving a sedating medication (midazolam and fentanyl combined, propofol, ketamine, dexmedetomidine, etomidate, pentobarbital, chloral hydrate, or methohexital). For admitted children, identification of imaging studies and use of procedural sedation included those performed on the initial or subsequent hospital day. We compared the proportion of children that received sedation across age groups and hospitals. Mixed effects logistic regression was used to identify factors associated with sedation, with random intercepts for hospital.

Results:

A total of 689,948 ED encounters (median age 7 years [IQR 2-13 years], 44.5% female) were included, and 33,206 (4.8%) received sedation. Rates of procedural sedation for CT and MRI were 2.3% and 17.4%, respectively. Across hospitals, rates of sedation for CT ranged from 0.7% to 8.1% (median 1.8% [IQR 1.2-2.9%]) and for MRI ranged from 2.0% to 39.7% (median 16.3% [IQR 8.8-26.8%]). Hospital-level proportions of children receiving sedation stratified by patient age are depicted in Figure 1. Rates of sedation for CT and MRI, respectively, were 1.6% and 26.1% for age < 1 year, 4.9% and 39.1% for 1-4 years, 1.9% and 15.6% for 5-11 years, and 0.9% and 3.9% for 12-17 years. Ages 1-4 years, male gender, government insurance, absence of a complex chronic condition, and receiving an MRI compared to CT were associated with increased odds of sedation (Table 1).

Conclusion(s):

Procedural sedation is more commonly utilized for MRI than for CT of the head and neck, with considerable variability across hospitals. Sedation was more often used for younger children and those without comorbidities. These findings will inform providers when considering need for sedation for advanced diagnostic imaging.