Comparing the Costs Associated with Anxiolytic Agents for Reducing Distress in Children Undergoing Laceration Repair in the Emergency Department
Bibliographic record
Abstract
Objectives The use of procedural medications for anxiolysis during laceration repair in children can mitigate distress, facilitate procedures, and avoid physical restraint. However, the optimal medication for use in the pediatric emergency department is unclear. This study compares hospital length of stay (LOS) and costs for 4 different procedural medications for pediatric laceration repair from the perspective of the Canadian health care system. Methods We used an individual-level state-transition model to compare (i) intranasal midazolam (INM), (ii) inhaled nitrous oxide (N 2 O), (iii) intranasal dexmedetomidine, and (iv) intravenous ketamine (IVK). Model inputs were informed by literature and expert consultations. LOS included time before, during, and after laceration repair, adjusting for adequacy of interventions and adverse events. Healthcare costs included personnel, equipment, and medication costs. We evaluated the drivers of model uncertainty using the TRansparent Uncertainty aSsessmenT (TRUST) tool and value of information analyses. Results The estimated LOS for N 2 O, INM, IVK, and intranasal dexmedetomidine were 78.34, 82.13, 103.37, and 114.55 minutes with the per-person estimated costs of $176.7, $122.79, $167.16, and $165.07, respectively. These results were limited by the low quality of available evidence for model inputs. The key parameters contributing to decision uncertainty were procedure time for N 2 O and IVK, with an expected value of $5.31 and $0.44 per person, respectively. Conclusion INM had the lowest expected healthcare cost, whereas children receiving N 2 O had the shortest expected LOS. Decision uncertainty was driven by the lack of relevant studies examining the length of procedure with N 2 O and IVK use.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".