Sedation provider practice variation: a survey analysis of pediatric emergency subspecialists and fellows.
OBJECTIVE
Pediatric emergency physicians use various techniques and medications when performing procedural sedation and analgesia. The goals of our study were to assess US pediatric emergency medicine subspecialists and fellows (PEMSSFs) for individual practice variation and to evaluate (1) the use of supplemental oxygen and capnography monitoring and (2) adverse sedation events (ADSEs).


METHODS
A Web-based tool was used to survey and analyze data collected from a selected group of PEMSSFs, regarding their responses to 5 common sedation case scenarios, use of supplemental oxygen and capnography monitoring, and ADSEs. Logistic regression analysis was used to examine the association between medication strategy and various levels of professional experience.


RESULTS
Two hundred one surveys were received. One hundred ninety-five of these were eligible for the study: 140 from specialists and 55 from fellows. Respondents used multiple combinations of pharmaceutical agents to the scenarios presented. For some scenarios, statistical association was found between medication selection strategy and longer professional experience. Sixty percent of respondents do not routinely provide oxygen supplementation. Despite current guidelines supporting the routine use of capnography monitoring, 45% of respondents never use it. Adverse sedation event was reported in 17 cases; all patients were discharged with no further complications. A statistical association was found between years of practitioner experience and the likelihood of reporting an ADSE (P < 0.018).


CONCLUSIONS
This group of PEMSSFs reported a wide spectrum of medication sedation strategies, dichotomous approaches to the use of oxygen supplementation and capnography monitoring, and a low rate of ADSEs.
Shavit
Itai
I
Emergency Department, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel. i_shavit@rambam.health.gov.il
Leder
Marc
M
Cohen
Daniel M
DM
D000328:Adult; D019296:Capnography / Q000706:statistics & numerical data; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D003625:Data Collection; D054810:Deep Sedation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D010146:Pain / Q000517:prevention & control; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data; D011595:Psychomotor Agitation / Q000517:prevention & control; D014481:United States
D006993:Hypnotics and Sedatives