Variation in Procedural Sedation Practices Among Children's Hospitals.
OBJECTIVE
Children often need procedural sedation for painful procedures. There are few data on type of provider, site of sedation, and agents used for procedural sedation in hospitals across the nation. The objective was to determine procedural sedation practices for hospitalized children outside the PICU and emergency department.


METHODS
Surveys were sent to 89 pediatric hospitalist (PH) leaders in hospitals belonging to the Child Health Corporation of America or the National Association of Children's Hospitals and Related Institutions.


RESULTS
We received responses from 56 PHs (63%), of whom 49 (55%) completed the survey. PHs provided sedation in 18 hospitals. Provider, setting, and agents used for procedural sedation varied. The primary providers of procedural sedation for abscess incision and drainage, renal biopsy, joint aspiration, computed tomography, and MRI were anesthesiologists. A significantly greater percentage of hospitals where PHs did not provide procedural sedation used the operating room for abscess incision and drainage compared with hospitals where PHs provided procedural sedation (63% vs 28%, respectively). Postoperative/abscess dressing change, vesicocystourethrogram, and ≥1 painful procedure were performed without sedation in significantly greater percentage of hospitals where PHs did not provide procedural sedation compared with hospitals where PHs provided procedural sedation.


CONCLUSIONS
There is variability in sedation practices in hospitals across the nation, which affects patient care and use of resources such as the operating room. In hospitals where PHs provide procedural sedation, there is less operating room use and fewer painful procedures for which no sedation is provided.
Washington University School of Medicine/St Louis Children's Hospital, St Louis, Missouri srinivasan_m@kids.wustl.edu.
Mythili
M
Srinivasan
Washington University School of Medicine/St Louis Children's Hospital, St Louis, Missouri.
Shobha
S
Bhaskar
Washington University School of Medicine/St Louis Children's Hospital, St Louis, Missouri.
Douglas W
DW
Carlson
D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D016292:Procedural Sedation / Q000379:methods*; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000145:classification / Q000706:statistics & numerical data; D011292:Premedication / Q000379:methods*; D013812:Therapeutics / Q000379:methods / Q000706:statistics & numerical data; D014481:United States
D006993:Hypnotics and Sedatives
pediatric hospitalists; procedural sedation; resource utilization