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Pediatric Procedural Sedation in the Community Emergency Department: Results From the ProSCED Registry

Sacchetti, Alfred MD*; Stander, Eric MD†; Ferguson, Nancy MD‡; Maniar, Gina DO§; Valko, Peter MD§

doi: 10.1097/PEC.0b013e31803e176c
Original Articles

Objectives: Emergency department procedural sedation practices for children have been reported for pediatric tertiary care centers. This report describes these same practice patterns and outcomes for community hospital-based general emergency physicians (EPs) in their treatment of pediatric patients.

Methods: The Procedural Sedation in the Community Emergency Department registry is a prospective observational database composed of consecutive EP-directed procedural sedation cases in community hospitals. Information on sedation cases is collected at the time of the patient encounter and entered into an Internet-accessed database.

Results: A total of 1028 procedural sedations were performed on 977 patients at 14 study sites, with 341 procedures performed in 339 patients younger than 21 years. The most common specified pediatric procedures performed included laceration repairs (n = 86, 25%), shoulder relocations (n = 78, 23%), and fracture care of the upper extremity (n = 56, 16%). Medications used included ketamine (n = 141, 41%), midazolam (n = 10, 32%), etomidate (n = 54, 16%), fentanyl (n = 51, 15%), and propofol (n = 47, 14%). Complications were reported in 2 cases (0.6%), 1 episode of apnea requiring a reversal agent and 1 episode of hypoxia responsive to supplemental oxygen. Of procedures attempted, 339 (99.4%) were successfully completed. Emergency physicians both directed the sedation and performed the procedure in 252 cases (74%), whereas in another 69 cases (20%), they directed the sedation for another physician performing the procedure. In 20 cases (5.8%), the EP directed sedation for a painless diagnostic study.

Conclusions: Community EPs in the Procedural Sedation in the Community Emergency Department registry deliver safe and effective pediatric sedation using a broad selection of agents.

*Our Lady of Lourdes Medical Center, Camden, NJ; †Nazareth Hospital, Philadelphia, PA; ‡St. Francis Medical Center, Trenton, NJ and §Ocean Medical Center, Brick, NJ.

Address correspondence and reprint requests to Alfred Sacchetti, MD, Department of Emergency Medicine, Our Lady of Lourdes Medical Center, 1600 Haddon Ave, Camden, NJ 08103. E-mail: a.sacchetti@worldnet.att.net.

© 2007 Lippincott Williams & Wilkins, Inc.