Who Paid for the study?
Children can be safely sedated by nonanesthesiologists
April 25, 2011 -- NEW YORK (Reuters Health) - Many specialties perform pediatric procedural sedation with no differences in major complication rates, according to findings published online today in Pediatrics.
Intensivists, emergency medicine physicians, radiologists, and hospitalists, among others, have increasingly been providing pediatric sedation, but whether complications are more or less associated with any particular group of specialists has been unclear.
Dr. James H. Hertzog from Alfred I. DuPont Hospital for Children, Wilmington, Delaware, and colleagues in the Pediatric Sedation Research Consortium investigated that question using data from 38 sites on patients who ranged in age from newborn to 18 years. The research team defined major complications as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesiology consult.
Out of 131,751 cases of sedation given outside of the operating room, there were no deaths, and other major complications were rare (122 total).
Sedation was most often administered by intensivists (58,222), emergency physicians (38,293), anesthesiologists (18,343), and pediatricians (12,113). Children were also sedated by pediatric residents or fellows, radiologists, surgeons, dentists, advanced practice nurses, certified registered nurse anesthetists, or registered nurses.
There was no statistical difference between providers' major complication rates either before or after adjustment for possible confounding variables.
Moreover, there was no significant difference between the types of major complication among providers.
"The rapid growth in the use of sedation services by nonanesthesiologists has been the subject of some concern," the researchers conclude. "Our data reveal that, within our consortium, there was no increased danger associated with pediatric procedural sedation provided by nonanesthesiologists."
"The application of our data to sites outside of our consortium will require rigorous evaluation of the skill level of the providers and the institution's systemic safeguards for the care of a sedated pediatric patient," they caution.
Source: http://bit.ly/ggVsDk
Pediatrics 2011;127:e1154-e1160.
Last Updated: 2011-04-25 14:56:07 -0400 (Reuters Health)
Impact of Provider Specialty on Pediatric Procedural Sedation Complication Rates
Kevin G. Couloures, DO, MPHa, Michael Beach, MDb, Joseph P. Cravero, MDb,c, Kimberly K. Monroe, MDd, James H. Hertzog, MDaaDepartment of Anesthesiology and Critical Care Medicine, Nemours Children's Clinic-Wilmington, Alfred I. duPont Hospital for Children, Wilmington, Delaware;
Departments of bAnesthesiology and
cPediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; and
dDepartment of Hospital-Based Medicine, Children's Memorial Hospital and Northwestern University, Chicago, Illinois
Objective To determine if pediatric procedural sedation-provider medical specialty affects major complication rates when sedation-providers are part of an organized sedation service.
Methods The 38 self-selected members of the Pediatric Sedation Research Consortium prospectively collected data under institutional review board approval. Demographic data, primary and coexisting illness, procedure, medications used, outcomes, airway interventions, provider specialty, and adverse events were reported on a self-audited, Web-based data collection tool. Major complications were defined as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesia consultation. Event rates per 10 000 sedations, 95% confidence intervals, and odds ratios were calculated using anesthesiologists as the reference group and were then adjusted for age, emergency status, American Society of Anesthesiologists physical status > 2, nil per os for solids, propofol use, and clustering by site.
Results Between July 1, 2004, and December 31, 2008, 131 751 pediatric procedural sedation cases were recorded; there were 122 major complications and no deaths. Major complication rates and 95% confidence intervals per 10 000 sedations were as follows: anesthesiologists, 7.6 (4.6–12.8); emergency medicine, 7.8 (5.5–11.2); intensivist, 9.6 (7.3–12.6); pediatrician, 12.4 (6.9–20.4); and other, 10.2 (5.1–18.3). There was no statistical difference (P > .05) among provider's complication rates before or after adjustment for potential confounding variables.
Conclusions In our sedation services consortium, pediatric procedural sedation performed outside the operating room is unlikely to yield serious adverse outcomes. Within this framework, no differences were evident in either the adjusted or unadjusted rates of major complications among different pediatric specialists.
Key Words: pediatric sedation • pediatric anesthesia • procedural sedation • patient safety
Abbreviations: ASA = American Society of Anesthesiologists • PPS = pediatric procedural sedation • PSRC = Pediatric Sedation Research Consortium • OR = odds ratio • CI = confidence interval • NPO = nil per os
Accepted Jan 24, 2011.
