152 Adverse Events in Pediatric Patients Undergoing Procedural Sedation in a General Emergency Department

Abstract

Procedural sedation is recommended as a way to decrease a patient's pain during a procedure. Failure to treat pain adequately has many negative consequences, including increased difficulty treating subsequent episodes of pain, increased risk of chronic pain, increased costs, and worse clinical outcomes. In spite of the many benefits of procedural sedation, the use of procedural sedation in the emergency department (ED) by emergency physicians has been questioned, especially in pediatric patients. Whether procedural sedation of infants and children can be safe and effective when done in a general emergency department where all ages of patients (eg, both adult and pediatric patients) are evaluated and treated) compared to a pediatric ED where only infants and children are treated has also been debated. Furthermore, there has not been a lot of data regarding procedural sedation in infants and children in a general ED. The objective of this study is to determine the incidence and types of adverse effects on procedural sedation in pediatric patients in a general ED. Prospective data collection of all pediatric patients (age < 22 years) undergoing procedural sedation in the ED on a standardized hospital-wide quality improvement (QI) form over 10 years. Data was analyzed by SPSS. There were 857 cases of procedural sedation in pediatric patients (age < 22 years), mean age 8.5 years, range 2 weeks to 21 years. The incidence of adverse events was only 4.4%. The adverse events included hypotension 1.5% (13/857), hypoxia (oxygen saturation < 90%) 0.8% (7/857), bradypnea/apnea 0.7% (6/857) and allergic reaction 0.001% (1/657). Other adverse events included cough, hiccups and emergence reaction. All patients responded well to simple measures such as repositioning of the head, supplemental oxygen and bag-valve mask for a very short period of time. There were no deaths, no intubations, no incidence of aspiration pneumonia, no inpatient hospitalizations, and no permanent morbidity in any of the patients. Only 1 patient was observed overnight in the ED observation unit due to an emergence reaction from ketamine and was well (symptom free) prior to discharge. The most common reasons for sedation were fracture reduction of a dislocated joint, laceration/wound repair, lumbar puncture, incision and drainage of an abscess. Pediatric sedation can be done safely in a general ED for a wide variety of procedures. The incidence of adverse events for pediatric patients undergoing procedural sedation in a general ED is similar to that for pediatric patients undergoing procedural sedation in a pediatric ED (in a freestanding Childrens Hospital). This suggests that concerns about the safety of emergency physicians doing procedural sedation, including emergency physicians doing procedural sedation in infants and children in a general emergency department, are unfounded.