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Behavioral Changes in Children After Emergency Department Procedural Sedation
Author(s) -
Pearce Jean I.,
Brousseau David C.,
Yan Ke,
Hainsworth Keri R.,
Hoffmann Raymond G.,
Drendel Amy L.
Publication year - 2018
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13332
Subject(s) - medicine , sedation , emergency department , anxiety , confidence interval , logistic regression , odds ratio , prospective cohort study , cohort , ketamine , emergency medicine , physical therapy , anesthesia , psychiatry
Objective The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department ( ED ) observed to experience negative postdischarge behaviors. Predictors of negative behaviors were evaluated, including anxiety. Methods This was a prospective cohort study of children receiving intravenous ketamine sedation for ED fracture reduction. The child's anxiety prior to sedation was measured with the Modified Yale Preoperative Anxiety Scale. Negative behavioral changes were measured with the Post‐Hospitalization Behavior Questionnaire 1 to 2 weeks after discharge. Descriptive statistics and odds ratios ( OR s) were calculated. Chi‐square test was used for comparisons between groups. Multivariable logistic regression models evaluated predictors of negative behavioral change after discharge. Results Ninety‐seven patients were enrolled; 82 (85%) completed follow‐up. Overall, 33 (40%) children were observed to be highly anxious presedation and 18 (22%) had significant negative behavior changes after ED discharge. Independent predictors for negative behaviors were high anxiety ( OR = 9.0, 95% confidence interval [ CI ] = 2.3–35.7) and nonwhite race ( OR = 6.5, 95% CI = 1.7–25.0). Conclusion For children undergoing procedural sedation in the ED , two in five children have high preprocedure anxiety and almost one in four have significant negative behaviors 1 to 2 weeks after discharge. Highly anxious and nonwhite children have increased risk of negative behavioral changes that have not been previously recognized in the ED setting.