Variations in sedating uncooperative, stable children for post-traumatic head CT.

ABSTRACT

OBJECTIVE: To characterize variations among pediatric emergency physicians and their hospital facilities regarding sedation of the uncooperative, stable child for head CT following closed head injury. DESIGN: Mail survey with two follow-up mailings. PARTICIPANTS: Surveys were sent to all members of the Emergency Medicine Section of the American Academy of Pediatrics (AAP). RESULTS: Of 596 surveys sent, 431 (72%) were returned, with 304 (51%) usable responses. Respondents annually sedate over 17,500 children for post-traumatic head CT. Formal training to sedate children for head CT was noted by 73%. Published guidelines for sedation are followed by 74%; 10% were unaware of the existence of published guidelines for sedation. Twenty-six percent of the respondents were very or somewhat dissatisfied with their sedation-related practices. In response to three clinical scenarios involving sedation of 8-month-old, 3-year-old, and 6-year-old children for head CT, midazolam was the most commonly chosen drug. Over 20 different sedation strategies were selected for each scenario. CONCLUSIONS: Sedation practices for post-traumatic pediatric head CT vary widely, among both physicians and individual practitioners. Institutional and individual sedation-relation policies vary widely as well. Variation and dissatisfaction with sedation practices may reflect uncertainty regarding optimal sedation strategies. Further cost-effectiveness research is necessary.