Utility of sedation for young children undergoing dimercaptosuccinic acid renal scans.
BACKGROUND
No studies have examined whether use of sedation during a Tc-99 m dimercaptosuccinic acid (DMSA) renal scan reduces patient discomfort.


OBJECTIVE
To compare discomfort level during a DMSA scan to the discomfort level during other frequently performed uroradiologic tests, and to determine whether use of sedation during a DMSA scan modifies the level of discomfort.


METHODS
We examined the discomfort level in 798 children enrolled in the Randomized Intervention for children with Vesicoureteral Reflux (RIVUR) and Careful Urinary Tract Infection Evaluation (CUTIE) studies by asking parents to rate their child's discomfort level with each procedure on a scale from 0 to 10. We compared discomfort during the DMSA scan and the DMSA image quality between centers in which sedation was used >90% of the time (sedation centers), centers in which sedation was used <10% of the time (non-sedation centers), and centers in which sedation was used on a case-by-case basis (selective centers).


RESULTS
Mean discomfort level was highest for voiding cystourethrogram (6.4), followed by DMSA (4.0), followed by ultrasound (2.4; P<0.0001). Mean discomfort level during the DMSA scan was significantly higher at non-sedation centers than at selective centers (P<0.001). No difference was apparent in discomfort level during the DMSA scan between sedation centers and selective centers (P=0.12), or between the sedation centers and non-sedation centers (P=0.80). There were no differences in the proportion with uninterpretable DMSA scans according to sedation use.


CONCLUSIONS
Selective use of sedation in children 12-36 months of age can reduce the discomfort level experienced during a DMSA scan.
University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, One Children's Hospital Drive, 4401 Penn Ave., Pittsburgh, PA, 15224, USA. nader.shaikh@chp.edu.
Nader
N
Shaikh
University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, One Children's Hospital Drive, 4401 Penn Ave., Pittsburgh, PA, 15224, USA.
Alejandro
A
Hoberman
Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Ron
R
Keren
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Anastasia
A
Ivanova
Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
Harvey A
HA
Ziessman
Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Gang
G
Cui
Division of Nephrology and Hypertension, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.
Tej K
TK
Mattoo
University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, One Children's Hospital Drive, 4401 Penn Ave., Pittsburgh, PA, 15224, USA.
Sonika
S
Bhatnagar
Pediatric Emergency Department, Wake Forest School of Medicine, Brenner Children's Hospital, Winston-Salem, NC, USA.
Milan D
MD
Nadkarni
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
Marva
M
Moxey-Mims
University of North Carolina Kidney Center, Chapel Hill, NC, USA.
William A
WA
Primack
D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010147:Pain Measurement; D010290:Parents / Q000523:psychology; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
Anxiolytic; Children; Dimercaptosuccinic acid; Renal scintigraphy; Sedation; Ultrasound; Voiding cystourethrogram