title: Unplanned Repeat Echocardiography with Sedation in Children: Patient Risk Factors.
abstract: Patient selection criteria for echocardiography with sedation in children are not well defined. We attempted to identify predictors of unplanned repeat echocardiography with sedation. This was a single-center, case-control study of echocardiograms performed in children aged 1-36 months. Cases underwent unplanned repeat examinations with sedation, while controls did not. Patient variables and study indications were compared. Logistic regression identified the most significant predictors. Cases (n = 104, median time to repeat echocardiogram 17 days, median age 12.9 months) were older than controls (n = 212, median age 5.0 months, P < 0.001). Significantly more cases than controls had structural cardiac disease (64 vs. 23 %) and anatomic complexity ≥moderate (38 vs. 5 %, P < 0.001 for both). Cases more often had Kawasaki disease (11 vs. 2 %), and controls more often had murmur (56 vs. 11 %, P < 0.001 for both). Logistic regression identified age 6 months to <2 years (OR 3.26, 95 % CI 1.70-6.28, P < 0.001), Kawasaki disease (OR 5.20, 95 % CI 1.46-18.50, P = 0.01), and known pre-echocardiogram anatomic complexity ≥moderate (OR 3.99, 95 % CI 1.64-9.66, P = 0.002) as significant risk factors. An indication for murmur was protective (OR 0.32, 95 % CI 0.13-0.76, P = 0.01). We identified several risk factors for unplanned repeat echocardiography with sedation in children, including age 6 months to <2 years, higher anatomic complexity, and Kawasaki disease. Murmur was a protective factor. These results may help pediatric echocardiography laboratories establish criteria for sedation.
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA. kstern@montefiore.org.|Division of Pediatric Cardiology, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Rosenthal 1, Bronx, NY, 10467, USA. kstern@montefiore.org.
authors.forename: Kenan W D
authors.initials: KW
authors.lastname: Stern
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.|Division of Pediatric Cardiology, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Rosenthal 1, Bronx, NY, 10467, USA.
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue; Belfer Building, Room 1006D, Bronx, NY, 10461, USA.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.|Division of Pediatric Cardiology, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Rosenthal 1, Bronx, NY, 10467, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mahgerefteh
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.|Division of Pediatric Cardiology, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Rosenthal 1, Bronx, NY, 10467, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Chambers
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.|Division of Pediatric Cardiology, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Rosenthal 1, Bronx, NY, 10467, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Lopez
mesh_terms: D000758:Anesthesia; D016022:Case-Control Studies; D002675:Child, Preschool; D016292:Procedural Sedation; D004452:Echocardiography; D006331:Heart Diseases; D006801:Humans; D007223:Infant; D012307:Risk Factors
keywords: Diagnostic error; Echocardiography; Pediatric and congenital heart disease; Procedural sedation