Adverse Reactions During Procedural Sedation in Children with Long Bone Fractures - Does BMI Matter?

Abstract

Procedural sedation is commonly used in emergency departments to facilitate reduction of pediatric long bone fractures. There is little published data that compares the risk of procedural sedation in obese vs healthy weight children despite childhood obesity being a serious problem in the United States. The body mass index (BMI) is used to define overweight and obese in adults. However in children, BMI criteria for overweight and obese vary by age and gender and thus are defined in percentiles. The CDC defines four BMI categories in children: (1) underweight is less than the fifth percentile, (2) healthy weight is the fifth percentile to less than the eighty-fifth percentile, (3) overweight is eighty-fifth percentile to less than the ninety-fifth percentile, and (4) obese is greater than or equal to the ninety-fifth percentile. There is a suggestion in the limited published data that obesity in children is associated with a greater incidence of complications such as hypoxia. PURPOSE: The purpose of the study was to determine if obese children as compared with healthy weight children age 2-17 years have a greater incidence of complications during procedural sedation for a long bone fracture. METHODS: The study was a retrospective chart review of patients age 2-17 years admitted to Women and Children’s Hospital of Buffalo Emergency Department during the time period of 2012-2014 with a diagnosis of a long bone fracture. Statistical analysis of the association between BMI and desaturation as well as sedation medication adverse effects were evaluated. We defined desaturations as less than or equal to 90% on pulse oximeter. RESULTS: Analyses were based on a total of 547 charts. Our findings indicate that the prevalence of desaturation with procedural sedation in children with obesity (10.16%) was approximately twice that of children with healthy weight (5.40%), p 0.071. The desaturation for children with overweight was 7.69%). CONCLUSION: Although not statistically significant, when evaluating children for procedural sedation physicians should consider children’s BMI and recognize that obese children may be at greater risk of respiratory compromise.