41 A Survey of Regional Paediatricians' CT/MRI Sedation Practices: Are we Following Published Guidelines?
Bibliographic record
Abstract
Paediatric CT and MRI imaging procedures often require sedation in order to increase patient comfort and quality of the study. To improve sedation outcomes and prevent complications, the American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) Committee on Drugs have issued guidelines for monitoring and managing paediatric patients during and after sedation. Evidence has shown that the application of these guidelines leads to a reduction in adverse outcomes. Currently, no Canadian guidelines are available. Therefore, many centres have developed their own protocols for pediatric sedation for imaging procedures. However, little is known about the pediatric sedation practices in smaller regional centers as CT and MRI are becoming increasingly available. Canadian physicians may not be aware of the published American guidelines. We performed a survey of paediatricians practicing in regional centres located outside a 50 km radius from any of the 5 Ontario Medical Schools. The survey consisted of an 18-item questionnaire. This study was designed to assess adherence to AAP/ASA guidelines, the agents that paediatricians commonly use for paediatric sedation, their comfort level with these agents, and their desire for additional information. Seventy-three surveys were faxed to paediatricians and 46 responses were received, resulting a response rate of 63%. Of the physicians who responded, 72% reported providing conscious sedation. Although most physicians followed some of the AAP/ASA guidelines, only 12% followed all seven of the guidelines we tested. Specifically, 82% maintained patients NPO, 82% documented a pertinent medical history, 73% recorded vital signs, 64% documented consent, 21% documented the child's ASA status and no patients were left unsupervised during or after the procedure. The two most commonly used agents for sedating paediatric patients were chloral hydrate (91%) and midazolam (58%). These were the two agents that physicians were most comfortable using with comfort levels of 6.5 and 6.2 respectively on a 7-point Likert scale. While pentobarbital was the next most commonly used sedative (33%), it only rated a comfort level of 4.7. Most physicians reported a need for additional information regarding paediatric conscious sedation (18% strongly agree, 46% agree). The preferred mode for relaying this information was professional guidelines (4.6 on a 5-point Likert scale). The results of this study suggest that a set of national guidelines for conscious sedation or greater dissemination of the existing AAP/ASA guidelines may improve future outcomes for Canadian children undergoing diagnostic imaging.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".