TY - JOUR
T1 - Procedural sedation in children with autism spectrum disorders in the emergency department
AU - Brown, James J.
AU - Gray, James M.
AU - Roback, Mark G.
AU - Sethuraman, Usha
AU - Farooqi, Ahmad
AU - Kannikeswaran, Nirupama
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/8
Y1 - 2019/8
N2 - Background and objectives: Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED. Methods: We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009–December 2016. Data were collected on children 1–18 years of age with ASD who were sedated in the ED. Results: There were 6020 ED visits by children with ASD, 126 (2.1%) of whom received sedation. The most frequent indications for sedation were laceration repair (24.6%), incision and drainage (17.5%), diagnostic imaging (14.3%), and physical examination (11.9%). The most common sedatives used were ketamine (50.8%) and midazolam (50.8%). Ketamine was most commonly given intravenously (71.9%), while midazolam was usually given intranasally (71.9%). Procedures could not be completed in 4 (3.2%) patients, and adverse events were noted in 23 (18.3%) patients. Only four (3.2%) patients required supplemental oxygenation, and one received positive pressure ventilation. Conclusions: Children with autism in the ED commonly received sedation; one in four of which were for non-painful diagnostic procedures or physical examination. Over one-third received sedation via a non-parenteral route for intended minimal sedation. Sedative medication dosing and observed adverse events were similar to those reported previously in children without ASD. Emergency providers must be prepared to meet the unique sedation needs of children with ASD.
AB - Background and objectives: Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED. Methods: We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009–December 2016. Data were collected on children 1–18 years of age with ASD who were sedated in the ED. Results: There were 6020 ED visits by children with ASD, 126 (2.1%) of whom received sedation. The most frequent indications for sedation were laceration repair (24.6%), incision and drainage (17.5%), diagnostic imaging (14.3%), and physical examination (11.9%). The most common sedatives used were ketamine (50.8%) and midazolam (50.8%). Ketamine was most commonly given intravenously (71.9%), while midazolam was usually given intranasally (71.9%). Procedures could not be completed in 4 (3.2%) patients, and adverse events were noted in 23 (18.3%) patients. Only four (3.2%) patients required supplemental oxygenation, and one received positive pressure ventilation. Conclusions: Children with autism in the ED commonly received sedation; one in four of which were for non-painful diagnostic procedures or physical examination. Over one-third received sedation via a non-parenteral route for intended minimal sedation. Sedative medication dosing and observed adverse events were similar to those reported previously in children without ASD. Emergency providers must be prepared to meet the unique sedation needs of children with ASD.
KW - Autism
KW - Emergency room
KW - Pediatric
KW - Sedation
UR - http://www.scopus.com/inward/record.url?scp=85055277645&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2018.10.025
DO - 10.1016/j.ajem.2018.10.025
M3 - Article
C2 - 30528052
AN - SCOPUS:85055277645
VL - 37
SP - 1404
EP - 1408
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 8
ER -