Background: Pain and anxiety accompany severe pediatric injuries and provoke psychologic harm. Procedural sedation offers an effective and humane treatment of these patients. In Rambam Health Care Campus, non-intubated children with severe trauma who are hemodynamically stable and have a Glasgow Coma Score (GCS) of 15 are treated with sedation if they require an emergent painful procedure or immobilization during computerized tomography.
Objective: We aimed to evaluate whether procedural sedation is associated with an increased risk for severe adverse events.
Methods. We conducted a retrospective cohort study and extracted data from the hospital medical records and from the Israel National Trauma Registry. The primary outcome measure was the rate of severe adverse events defined as death, cardiopulmonary resuscitation, and neurologic sequela on hospital discharge. The secondary outcome was unanticipated endotracheal intubation due to sedation.
Results: During the 10-year study period 1,182 patients aged 0-18 years with an injury severity score (ISS) > 15 were admitted to the trauma-bay. Of the 565 patients who were spontaneously breathing on admission, 455 hemodynamically stable patients had GCS of 15. Two hundreds and one patients were treated with sedation; 144 (71.6%) had CT scan, 35 (17.5%) wound debridement, and 22 (10.9%) fracture reduction. There were no deaths, cardiopulmonary resuscitations or neurologic sequelae. There were 2 (1%) cases of unanticipated endotracheal intubation.
Conclusions: The findings suggest that fully conscious non-intubated children with severe trauma who were hemodynamically stable have a low risk for severe adverse events due to sedation and can be safely sedated.
