Sedation for Pediatric CT Scanning: is Radiology Becoming a Drug-free Zone?

Introduction: Cooperation for a diagnostic study is a frequent indication for pediatric procedural sedation. This study examines the continued need for sedation in the era of fast helical computerized tomography (CT) scanners.

Methods: Medical records of children younger than 72 months undergoing CT scans were systematically reviewed to identify the use of procedural sedation to complete their diagnostic studies. Statistical analysis was through ANOVA and regression modeling.

Results: A total of 104 patients underwent 122 CT studies. Requests originated from 3 sources: 59.8% ED (n = 73), 38.5% Neonatal Intensive Care Unit (n = 47), and 1.6% Pediatric Ward (n = 2). Studies performed included: 79.5% head/facial (n = 97), 15.6% abdomen/pelvis (n = 19), and 5.9% other (n = 6). The mean ages of all study patients was 23.4 (+/-2.4) months with a median of 14 months. Only 8.6% patients (n = 9) received any sedation. The mean age of sedated patients was 18.8 (+/-2.7) months with a median of 21 months. With the exception of one 4-month-old, all other sedated children were between 12 and 30 months. Sedative use occurred in 36.4% of patients in this age group, which was significantly greater than the remainder of the study group (OR 56.5, 95% CI 9-1091, P < 0.001) Sedative agents used included: diphenhydramine (4), pentobarbital (1), propofol (1), ketamine (1), midazolam (1), diphenhydramine/pentobarbital (1).

Conclusions: Procedural sedation is infrequently used in infants and young children undergoing helical CT studies.