"Feed and Swaddle" Sedation of Infants Undergoing Head CT for Minor Head Injury in the Pediatric Emergency Department

Background: Minor head injuries in infants are a common cause for emergency department referral. Several guidelines determine when a CT is needed. There is no clear time frame for the completion of a required head CT. Previous studies have shown that the use of procedural sedation for CT completion is rarely used. Most CTs are performed with the child sleeping after using a modified "feed and swaddle (FAS) method”. In this study we explored the time to completion of head CTs in infants with minor head injuries comparing FAS to sedation.

Methods: This is a retrospective case control study of infants from birth to one year of age at the pediatric emergency department requiring a head CT (2014-2019)

Results: 281 children underwent a head CT during the study period. The average age was 5.4 months. 196 of the children (69.7%) had abnormal findings on CT.

268 children underwent CT with the FAS method and 13 required sedation (4.6%).

The mean time to CT completion was similar with FAS and sedation (85.5 vs 86 min. respectively)

Those with abnormal findings performed a CT in less time (77 vs. 109 minutes respectively)

None of the patients had any sequalae or required interventions before or after CT completion.

Conclusion: The time to CT completion in infants with head injury is similar with and without sedation. There is a trend to quicker CT completion in cases with abnormal findings. The use of FAS seems safe and does not delay CT completion.