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Am J Emerg Med. 2020 Feb 19. pii: S0735-6757(20)30108-X. doi: 10.1016/j.ajem.2020.02.035. [Epub ahead of print]

Sedatives used in children to obtain head CT in the emergency department.

Author information

1
Emory University, Department of Pediatrics, Division of Emergency Medicine, United States of America. Electronic address: beckyburger@emory.edu.
2
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America. Electronic address: janet.figueroa@emory.edu.
3
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America. Electronic address: courtney.mccracken@emory.edu.
4
Pediatric Emergency Medicine Associates/Children's Healthcare of Atlanta at Scottish Rite Hospital, United States of America. Electronic address: michael.mallory@choa.org.
5
Children's Healthcare of Atlanta, Division of Critical Care Medicine, United States of America. Electronic address: pradip.kamat@choa.org.

Abstract

OBJECTIVES:

Children in the emergency department who require computerized tomography (CT) of the head often are given sedative medications to facilitate completion of the study with adequate imaging. A prior study found the two most common medications used to obtain head CT in children were pentobarbital and chloral hydrate; however, these medications have become less popular. We hypothesized that there was variability in medication choice amongst providers in the emergency department and there has been a change in the preferred sedatives used in the last decade.

METHODS:

We conducted a retrospective multicenter cross-sectional study of children 0-18 years old who received a medication with sedative properties and underwent head CT while in the emergency department from 2007 to 2018, using the Pediatric Health Information System (PHIS) database. The primary outcome measure was the frequency of administration of drugs within an individual sedative class.

RESULTS:

We analyzed 24,418 patient encounters, of whom 53% received an opioid and 41% received a benzodiazepine. There were statistically significant decreases in the use of barbiturates, chloral hydrate, anti-emetic sedatives, and opioids, while increases in barbiturate combination drugs, benzodiazepines and dexmedetomidine were observed over the study period. The majority of medications were administered parenterally.

CONCLUSION:

There is wide variability in sedatives used in children to obtain head CT and the preferred drugs have shifted over the last decade.

KEYWORDS:

Emergency department; Head CT; Pediatrics; Sedation; Sedatives

PMID:
32107128
DOI:
10.1016/j.ajem.2020.02.035

Conflict of interest statement

Declaration of competing interest No author has any conflict of interest to declare.

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