title: The impact of procedural sedation on diagnostic errors in pediatric echocardiography.
abstract: BACKGROUND
  Infants and young children frequently have difficulty remaining still for an echocardiographic examination, potentially leading to poor study quality, increasing the likelihood of diagnostic errors. Sedation is believed to improve echocardiographic quality, but its effectiveness has not been demonstrated. The aim of this study was to test the hypothesis that sedation would improve study quality and reduce diagnostic errors.
  
  
  METHODS
  Outpatient echocardiograms from children aged ≤36 months obtained from January 2008 to June 2009 were examined. Variables related to image quality, report completeness, and sedation use were collected. Diagnostic errors were identified and categorized. Multivariate analysis identified the odds ratios (OR) and 95% confidence intervals (CI) for risk factors for potentially preventable diagnostic errors and the impact of sedation on these errors.
  
  
  RESULTS
  Among 2,003 echocardiographic examinations, sedation was used in 498 (25%). The overall diagnostic error rate was 6.5%. Most errors (66%) were potentially preventable. Multivariate analysis identified the following risk factors for potentially preventable errors: precardiac procedure (OR, 2.19; 95% CI, 1.05-4.59; P = .04), moderate anatomic complexity (OR, 3.91; 95% CI, 2.25-6.81; P < .001), and high anatomic complexity (OR, 8.36; 95% CI, 3.57-19.6; P < .001). Sedation was independently associated with lower odds of potentially preventable diagnostic errors (OR, 0.47; 95% CI, 0.27-0.80; P = .006). Echocardiographic examinations with sedation had fewer image quality concerns (22% vs 60%) and fewer incomplete reports (3% vs 20%) (P < .001).
  
  
  CONCLUSIONS
  Most echocardiographic diagnostic errors among infants and young children are potentially preventable. Sedation is associated with a lower likelihood of these diagnostic errors, fewer imaging quality concerns, and fewer incomplete reports.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: kstern@montefiore.org.
authors.forename: Kenan W D
authors.initials: KW
authors.lastname: Stern
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Pediatric/Congenital Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Benavidez
mesh_terms: D001900:Boston / Q000453:epidemiology; D002675:Child, Preschool; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000187:drug effects* / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D006993:Hypnotics and Sedatives
keywords: Diagnostic errors; Echocardiography; Pediatric and congenital heart disease; Procedural sedation