Use of sedation in children receiving computed tomography after head injuries

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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.

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