title: Variation in the use of procedural sedation for incision and drainage of skin and soft tissue infection in pediatric emergency departments.
abstract: OBJECTIVE
  Little is known about procedural sedation use for anxiety and pain associated with skin and soft tissue infections (SSTIs) requiring incision and drainage (I&D). Our objectives were therefore (1) to characterize the use of procedural sedation use for SSTI I&D procedures in pediatric emergency departments (EDs), (2) to compare the frequency of procedural sedation for I&D across hospitals, and (3) to determine factors associated with use of procedural sedation for I&D.
  
  
  METHODS
  We performed a retrospective cohort study of pediatric EDs contributing to the Pediatric Health Information Systems database in 2010. Cases were identified by primary International Classification of Diseases, 9th revision, Clinical Modification procedure codes for I&D. We used descriptive statistics to describe procedural sedation use across hospitals and logistic generalized linear mixed models to identify factors associated with use of procedural sedation.
  
  
  RESULTS
  There were 6322 I&D procedures, and procedural sedation was used in 24% of cases. Hospital-level use of procedural sedation varied widely, with a range of 2% to 94% (median 17%). Procedural sedation use was positively associated with sensitive body site, female gender, and employer-based insurance, and negatively associated with African American race and increasing age. Estimates of hospital-level use of procedural sedation for a referent case eliminating demographic differences exhibit similar variability with a range of 5% to 97% (median 34%).
  
  
  CONCLUSIONS
  Use of procedural sedation for SSTI I&D varies widely across pediatric EDs, and the majority of variation is independent of demographic differences. Additional work is needed to understand decision-making and to standardize delivery of procedural sedation in children requiring I&D.
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington neil.uspal@seattlechildrens.org.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Uspal
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Eileen J
authors.initials: EJ
authors.lastname: Klein
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
authors.affiliation: Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Assaf P
authors.initials: AP
authors.lastname: Oron
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D010146:Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D012874:Skin Diseases, Infectious / Q000601:surgery*; D018461:Soft Tissue Infections / Q000601:surgery*; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives
keywords: incision and drainage; procedural sedation; variation in care
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