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

Pediatric emergency care (Impact Factor: 1.05). 01/2014; 30(1):1-7. DOI: 10.1097/PEC.0000000000000059
Source: PubMed


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.
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.
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.
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.

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    • "Radiation from cranial CT scans can cause lethal malignancies with higher risk in younger age groups [1-4]. Children may require sedation to allow imaging with consequent sedation-associated risks [5,6]. They also have resource implications for Emergency Departments (EDs) and the health system as a whole [7]. "
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    ABSTRACT: Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria. This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting. Trial registration The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014).
    Full-text · Article · Jun 2014 · BMC Pediatrics
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    ABSTRACT: Objective: The aim of this study was to determine the use of procedural sedation for head trauma-related computed tomography of the brain (CTB) in children and its association with age and Glasgow Coma Scale (GCS) scores. Patients and methods: A retrospective review was carried out of charts of children undergoing a CTB for head injury at a tertiary paediatric emergency department with an annual census of 82 000 over a 2-year period. Patients were identified through the database of an ongoing prospective study involving children with head injuries of all severity. We extracted demographics, GCS scores, characteristics of sedation used for CTBs and adverse events. Results: In total, 477 patients underwent CTB after head injury. Thirty-three were intubated for medical management of severe head injury and two received midazolam for seizure management. Of the remaining 442, 67.4% were male and their mean age was 8.3 years. 30.8% had abnormal CTBs and 2.0% required neurosurgery. Twenty-eight [6.3%, 95% confidence interval (CI) 4.2-9.0] were sedated for CTB including 10 who initially failed CTB without sedation. Two patients were intubated for CTB. The sedation rate was 18.4% in patients less than 5 years versus 1.0% in children of age 5 years or more [odds ratio (OR) 22.8, 95% CI 6.7-119.1, P<0.001]. The sedation rate was 3.7% in patients with initial GCS 12 or less versus 10.2% in children with GCS more than 12 (OR 0.34, 95% CI 0.1-2.2, P=0.27). Conclusion: Children with head injuries who require CTB are infrequently sedated. Younger children are more likely to receive sedation. These data will be useful for the assessment of CTB-associated risks.
    No preview · Article · Sep 2014 · European Journal of Emergency Medicine

  • No preview · Article · Sep 2015 · Canadian Medical Association Journal