Abstract
Background: Nuclear medicine investigations are essential diagnostic tools in paediatric urology. Child-orientated examination techniques and the avoidance of sedation or anaesthesia vary in different institutions. We aimed at evaluating child friendly measures in our department to identify the potential for improvement. Based on these data, we changed the standards regarding the sedation policy and consequently re-evaluated sedation rates. Methods: Four-hundred thirty-five consecutive investigations were evaluated regarding the need for sedation, outcome and patient satisfaction at our department. After the revision of our department standards, we re-evaluated 159 examinations. Statistical analysis was performed with JUMBO (Java-supported Münsterian biometrical platform). Results: Eighty-six percent (60/70) would agree to perform an investigation under identical conditions again. Seventy-seven percent (17/22) of eligible patients >5 years of age felt good during the investigation. By changing our sedation policy, we could reduce the sedation rate from 27.1% to 7.5% (p < 0.0001; OR 0.219 95% CI 0.111–0.423). Conclusion: The evaluation of child friendly examination protocols demonstrated high reliability and patient satisfaction using situational sedation with a relatively high proportion of patients being sedated. Through protocol adaption with clear age limits, individual indication and education of staff, as well as the use of optimized sedatives, the need for sedation could be further reduced whilst maintaining a high patient satisfaction.
Highlights
Nuclear medicine investigations like 99mTc-mercaptoacetyltriglycin (MAG3) and 99mTc-dimercaptosuccinic acid (DMSA) scans play an essential role in the evaluation of congenital malformations of the urogenital system [1,2]
While the Guidelines of the Nuclear Medicine Society are clear about the importance of child friendly examination protocols, there is only a small literature on the assessment of the level of discomfort during nuclear medicine investigations in children [3]
This study showed how a protocol evaluation with a concentrated effort to optimize child friendly examination conditions led to lower sedation rates while maintaining satisfactory outcomes
Summary
Nuclear medicine investigations like 99mTc-mercaptoacetyltriglycin (MAG3) and 99mTc-dimercaptosuccinic acid (DMSA) scans play an essential role in the evaluation of congenital malformations of the urogenital system [1,2]. With these malformations being among the commonest, there is a high frequency of these examinations being performed. We aimed at evaluating child friendly measures in our department to identify the potential for improvement. Based on these data, we changed the standards regarding the sedation policy and re-evaluated sedation rates. Through protocol adaption with clear age limits, individual indication and education of staff, as well as the use of optimized sedatives, the need for sedation could be further reduced whilst maintaining a high patient satisfaction
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