Dissociative and Deep Sedations Administered by Trained Unsupervised Pediatric Residents in Israeli Emergency Departments

Abstract

Study objective

To cover pediatric emergency physicians' off-hours, third-year pediatric residents in Israel are trained for unsupervised administration of emergency department (ED) dissociative and deep sedation. We assessed the frequency of critical sedation events associated with resident-performed sedations.

Methods

We conducted a retrospective chart review on all patients receiving intravenous sedation across 10 pediatric EDs between January 2018 and September 2022. We defined a critical sedation event as one or more of the following: chest compressions, tracheal intubation, neuromuscular blockers, vasopressors, atropine for bradycardia, aspiration syndrome, death, or unplanned hospital admission due to sedation. We liaised with the Ministry of Health’s reporting department and ED directors to verify complete identification of all sentinel events.

Results

Pediatric residents and pediatric emergency physicians performed 12,733 and 10,845 sedations, respectively, most frequently for fracture reduction (44.4%) and laceration repair (25.6%). Patients’ mean (SD) age was 6.9 (4.4) years. Residents and emergency physicians administered ketamine or propofol alone in 6,473 and 3,465 cases, respectively, with drug combinations for the remainder. We identified 6 critical sedation events, of which 3 were resident-performed sedations. The frequency of critical sedation events among pediatric residents and emergency physicians was 0.024% (95% CI, 0.005% to 0.069%) and 0.028% (95% CI, 0.006% to 0.080%), respectively.

Conclusion

We observed a low frequency of critical sedation events in this large sample of dissociative and deep sedations performed by pediatric residents and pediatric emergency physicians. Our findings suggest that ED sedation by unsupervised, trained pediatric residents is a safe practice in Israel.