title: Impact of provider specialty on pediatric procedural sedation complication rates.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Couloures
authors.forename: Michael
authors.initials: M
authors.lastname: Beach
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Cravero
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Monroe
authors.forename: James H
authors.initials: JH
authors.lastname: Hertzog
mesh_terms: D000293:Adolescent; D000776:Anesthesiology / Q000592:standards / Q000639:trends; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D016001:Confidence Intervals; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D016208:Databases, Factual; D005260:Female; D006282:Health Personnel / Q000592:standards* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008511:Medicine / Q000592:standards* / Q000639:trends; D016017:Odds Ratio; D010372:Pediatrics / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management