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Pharmacological Sedation for Cranial Computed Tomography in Children After Minor Blunt Head Trauma

Hoyle, John D. Jr MD*†; Callahan, James M. MD; Badawy, Mohamed MD§; Powell, Elizabeth MD; Jacobs, Elizabeth MD; Gerardi, Michael MD#; Melville, Kraig MD**; Miskin, Michelle MS††; Atabaki, Shireen M. MD, MPH‡‡; Dayan, Peter MD, MSc§§; Holmes, James F. MD, MPH∥∥; Kuppermann, Nathan MD, MPH∥∥¶¶; on behalf of the Traumatic Brain Injury Study Group for the Pediatric Emergency Care Applied Research Network (PECARN)

doi: 10.1097/PEC.0000000000000059
Original Articles

Objective: Children evaluated in emergency departments for blunt head trauma (BHT) frequently undergo computed tomography (CT), with some requiring pharmacological sedation. Cranial CT sedation complications are understudied. The objective of this study was to document the frequency, type, and complications of pharmacological sedation for cranial CT in children.

Methods: We prospectively enrolled children (younger than 18 years) with minor BHT presenting to 25 emergency departments from 2004 to 2006. Data collected included sedation agent and complications. We excluded patients with Glasgow Coma Scale scores of less than 14.

Results: Of 57,030 eligible patients, 43,904 (77%) were enrolled in the parent study; 15,176 (35%) had CT scans performed or planned, and 527 (3%) received pharmacological sedation for CT. Sedated patients’ characteristics were as follows: median age, 1.7 years (interquartile range, 1.1–2.5 years); male 61%; Glasgow Coma Scale score of 15, 86%; traumatic brain injury on CT, 8%. There were 488 patients (93%) who received 1 sedative. Sedation use (0%–21%) and regimen varied by site. Pentobarbital (n = 164) and chloral hydrate (n = 149) were the most frequently used agents. Sedation complications occurred in 49 patients (9%; 95% confidence interval [CI], 7%–12%): laryngospasm 1 (0.2%; 95% CI, 0%–1.1%), failed sedation 31 (6%; 95% CI, 4%–8%), vomiting 6 (1%; 95% CI, 0.4%–2%), hypotension 13 (4%; 95% CI, 2%–7%), and hypoxia 1 (0.2%; 95% CI, 0%–2%). No cases of apnea, aspiration, or reversal agent use occurred. One patient required intubation. Vomiting and failed sedation were most common with chloral hydrate.

Conclusions: Pharmacological sedation is infrequently used for children with minor BHT undergoing CT, and complications are uncommon. The variability in sedation medications and frequency suggests a need for evidence-based guidelines.

From the *Departments of Emergency Medicine and Pediatrics, Western Michigan University School of Medicine; †Department of Emergency Medicine, Michigan State University; ‡Departments of Emergency Medicine and Pediatrics, SUNY-Upstate Medical University, Syracuse, NY; §Departments of Emergency Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY; ∥Department of Pediatrics, Northwestern University’s Feinberg School of Medicine, Chicago, IL; ¶Department of Pediatrics, Holy Cross Hospital, Silver Springs, MD; #Department of Emergency Medicine, Atlantic Health System, Morristown Memorial Hospital, Morristown, NJ; **Department of Emergency Medicine, Calvert Memorial Hospital, Prince Frederick, MD; ††Department of Pediatrics, University of Utah, Salt Lake City, UT; ‡‡Children’s National Medical Center/Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine, Washington, DC; §§Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY; and Departments of ∥∥Emergency Medicine and ¶¶Pediatrics, University of California, Davis School of Medicine, Davis, CA.

Disclosure: The authors declare no conflict of interest.

This work has been previously presented in part at the Pediatric Academic Society Meeting, Honolulu, HI, in May 2008 and at the Society of Academic Emergency Medicine, Washington, DC, in June 2008.

Reprints: John D. Hoyle, Jr, MD, Helen DeVos Children’s Hospital, Emergency Department, MC 49, 100 Michigan St NE, Grand Rapids, MI 49503 (e-mail: jdhoyle@hotmail.com).

This work was supported by a grant from the Health Resources and Services Administration/Maternal and Child Health Bureau, Division of Research, Training, and Education, and the Emergency Medical Services of Children Program (R40MC02461). The Pediatric Emergency Care Applied Research Network (PECARN) is supported by cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008 from the Emergency Medical Services of Children Program of the Health Resources and Services Administration/Maternal and Child Health Bureau.

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© 2014 Lippincott Williams & Wilkins, Inc.