Unplanned Repeat Echocardiography with Sedation in Children: Patient Risk Factors.

Abstract

Patient selection criteria for echocardiography with sedation in children are not well defined. We attempted to identify predictors of unplanned repeat echocardiography with sedation. This was a single-center, case-control study of echocardiograms performed in children aged 1-36months. Cases underwent unplanned repeat examinations with sedation, while controls did not. Patient variables and study indications were compared. Logistic regression identified the most significant predictors. Cases (n=104, median time to repeat echocardiogram 17days, median age 12.9months) were older than controls (n=212, median age 5.0months, P<0.001). Significantly more cases than controls had structural cardiac disease (64 vs. 23%) and anatomic complexity ≥moderate (38 vs. 5%, P<0.001 for both). Cases more often had Kawasaki disease (11 vs. 2%), and controls more often had murmur (56 vs. 11%, P<0.001 for both). Logistic regression identified age 6months to <2years (OR 3.26, 95% CI 1.70-6.28, P<0.001), Kawasaki disease (OR 5.20, 95% CI 1.46-18.50, P=0.01), and known pre-echocardiogram anatomic complexity ≥moderate (OR 3.99, 95% CI 1.64-9.66, P=0.002) as significant risk factors. An indication for murmur was protective (OR 0.32, 95% CI 0.13-0.76, P=0.01). We identified several risk factors for unplanned repeat echocardiography with sedation in children, including age 6months to <2years, higher anatomic complexity, and Kawasaki disease. Murmur was a protective factor. These results may help pediatric echocardiography laboratories establish criteria for sedation.