28 Procedural Sedation for Fracture Reduction in Children with and without Attention Deficit Hyperactivity Disorder.

Abstract

BACKGROUND: Children with Attention Deficit Hyperactivity Disorder (ADHD) have a higher rate of more severe injuries than the general population. However, it is unclear if their ADHD causes them to respond differently to procedural sedation required to treat these injuries.PURPOSE OF STUDY: To compare procedural sedation for children with and without ADHD for forearm fracture reduction as measured by drug dosages, vital signs, and sedation scores.METHODS: Retrospectively, 44 patients with ADHD and 41 controls sedated for forearm fracture reduction in the emergency department (ED) at a children's hospital were identified. All patients received fentanyl and midazolam.SUMMARY OF RESULTS: Demographics, drug dosages, maximal and minimum vital signs, and sedation scores did not significantly differ. Drug dosages did not differ between ADHD (mean 2.02 mcg/kg fentanyl, 0.09 mg/kg midazolam) and controls (1.93 mcg/kg fentanyl, 0.08 mg/kg midazolam), p = 0.87 and 0.91, respectively. The average sedation score (on a scale of 1–5) was 2.0 for both groups, p = .87. Mean ED visit duration differed between ADHD (275 minutes) and controls (174 minutes), ph 0.001. Sedation duration for ADHD patients was 54.8 minutes and for controls 40.6 minutes, ph 0.02. Equivalent numbers of patients received pre-medication and supplemental oxygen for mild oxygen desaturations. Only one patient (control) required bag-valve mask ventilation and naloxone for post-procedural apnea. All procedures were completed successfully.CONCLUSIONS: Children with and without ADHD were equally and successfully sedated with the same total drug dosages. The differences in sedation duration and total length of stay warrant further investigation.