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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1745831
Original Article

Creation of a Pediatric Sedation Risk Assessment Scoring System: A Novel Method to Stratify Risk

Kevin G. Couloures 
1   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
,
Michael P. Anderson
2   Department of Biostatistics, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
C. L. Hill  Jr.
3   Duke Clinical Research Institute, Durham, North Carolina, United States
,
Allshine Chen
2   Department of Biostatistics, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
Mark A. Buckmaster
4   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Abstract

This study aimed to create a pediatric sedation scoring system independent of the American Society of Anesthesiology Physical Status (ASA-PS) classification that is predictive of adverse events, facilitates objective stratification, and resource allocation. Multivariable regression and machine learning algorithm analysis of 134,973 sedation encounters logged in to the Pediatric Sedation Research Consortium (PSRC) database between July 2007 and June 2011. Patient and procedure variables were correlated with adverse events with resultant β-regression coefficients used to assign point values to each variable. Point values were then summed to create a risk assessment score. Validation of the model was performed with the 2011 to 2013 PSRC database followed by calculation of ROC curves and positive predictive values. Factors identified and resultant point values are as follows: 1 point: age ≤ 6 months, cardiac diagnosis, asthma, weight less than 5th percentile or greater than 95th, and computed tomography (CT) scan; 2 points: magnetic resonance cholangiopancreatography (MRCP) and weight greater than 99th percentile; 4 points: magnetic resonance imaging (MRI); 5 points: trisomy 21 and esophagogastroduodenoscopy (EGD); 7 points: cough at the time of examination; and 18 points: bronchoscopy. Sum of patient and procedural values produced total risk assessment scores. Total risk assessment score of 5 had a sensitivity of 82.69% and a specificity of 26.22%, while risk assessment score of 11 had a sensitivity of 12.70% but a specificity of 95.29%. Inclusion of ASA-PS value did not improve model sensitivity or specificity and was thus excluded. Higher risk assessment scores predicted increased likelihood of adverse events during sedation. The score can be used to triage patients independent of ASA-PS with site-specific cut-off values used to determine appropriate sedation resource allocation.

Keywords

pediatric procedural sedation - adverse events - risk stratification


Publication History

Received: 27 November 2021

Accepted: 21 February 2022

Article published online:
17 May 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Coté CJ, Wilson S. American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics 2019; 143 (06) e20191000
    CrossrefPubMedGoogle Scholar
  • 2 Biber JL, Allareddy V, Allareddy V. et al. Prevalence and predictors of adverse events during procedural sedation anesthesia- outside the operating room for esophagogastroduodenoscopy and colonoscopy in children: age is an independent predictor of outcomes. Pediatr Crit Care Med 2015; 16 (08) e251-e259
    CrossrefPubMedGoogle Scholar
  • 3 Green SM, Roback MG, Krauss B. et al; Emergency Department Ketamine Meta-Analysis Study Group. Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children. Ann Emerg Med 2009; 54 (02) 171-80.e1 , 4
    CrossrefPubMedGoogle Scholar
  • 4 Green SM, Roback MG, Krauss B. et al; Emergency Department Ketamine Meta-Analysis Study Group. Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children. Ann Emerg Med 2009; 54 (02) 158-68.e1 , 4
    CrossrefPubMedGoogle Scholar
  • 5 Riley R, Holman C, Fletcher D. Inter-rater reliability of the ASA physical status classification in a sample of anaesthetists in Western Australia. Anaesth Intensive Care 2014; 42 (05) 614-618
    CrossrefPubMedGoogle Scholar
  • 6 Grunwell JR, McCracken C, Fortenberry J, Stockwell J, Kamat P. Risk factors leading to failed procedural sedation in children outside the operating room. Pediatr Emerg Care 2014; 30 (06) 381-387
    CrossrefPubMedGoogle Scholar
  • 7 Knuf KM, Manohar CM, Cummings AK. Addressing inter-rater variability in the ASA-PS classification system. Mil Med 2020; 185 (5-6): e545-e549
    CrossrefPubMedGoogle Scholar
  • 8 Grunwell JR, Marupudi NK, Gupta RV. et al. Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies. Paediatr Anaesth 2016; 26 (06) 628-636
    CrossrefPubMedGoogle Scholar
  • 9 Rassi Jr. A, Rassi A, Little WC. et al. Development and validation of a risk score for predicting death in Chagas' heart disease. N Engl J Med 2006; 355 (08) 799-808
    CrossrefPubMedGoogle Scholar
  • 10 Altman DG, Royston P. What do we mean by validating a prognostic model?. Stat Med 2000; 19 (04) 453-473
    CrossrefPubMedGoogle Scholar
  • 11 Coté CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000; 105 (4, Pt. 1): 805-814
    CrossrefPubMedGoogle Scholar
  • 12 Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH. Pediatric Sedation Research Consortium. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 2009; 108 (03) 795-804
    CrossrefPubMedGoogle Scholar
  • 13 Bellolio MF, Puls HA, Anderson JL. et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis. BMJ Open 2016; 6 (06) e011384
    CrossrefPubMedGoogle Scholar
  • 14 Cravero JP, Blike GT, Beach M. et al; Pediatric Sedation Research Consortium. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics 2006; 118 (03) 1087-1096
    CrossrefPubMedGoogle Scholar
  • 15 Scherrer PD, Mallory MD, Cravero JP, Lowrie L, Hertzog JH, Berkenbosch JW. Pediatric Sedation Research Consortium. The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth 2015; 25 (07) 689-697
    CrossrefPubMedGoogle Scholar
  • 16 Nasr VG, DiNardo JA, Faraoni D. Development of a pediatric risk assessment score to predict perioperative mortality in children undergoing noncardiac surgery. Anesth Analg 2017; 124 (05) 1514-1519
    CrossrefPubMedGoogle Scholar
  • 17 Valencia E, Staffa SJ, Faraoni D, DiNardo JA, Nasr VG. Prospective external validation of the pediatric risk assessment score in predicting perioperative mortality in children undergoing noncardiac surgery. Anesth Analg 2019; 129 (04) 1014-1020
    CrossrefPubMedGoogle Scholar
  • 18 Kamat PP, McCracken CE, Gillespie SE. et al. Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database. Pediatr Crit Care Med 2015; 16 (01) 11-20
    CrossrefPubMedGoogle Scholar
  • 19 Moons KGM, de Groot JAH, Bouwmeester W. et al. Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist. PLoS Med 2014; 11 (10) e1001744
    CrossrefPubMedGoogle Scholar
  • 20 Kamat PP, McCracken CE, Simon HK. et al. Trends in outpatient procedural sedation: 2007-2018. Pediatrics 2020; 145 (05) e20193559
    CrossrefPubMedGoogle Scholar
  • 21 Parshuram CS, Hutchison J, Middaugh K. Development and initial validation of the Bedside Paediatric Early Warning System score. Crit Care 2009; 13 (04) R135
    CrossrefPubMedGoogle Scholar