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Zhu Z, Liu L, Du M, Ye M, Xu X, Xu Y. Pediatric Sedation Assessment and Management System (PSAMS) for Pediatric Sedation in China: Development and Implementation Report. JMIR Med Inform 2024; 12:e53427. [PMID: 39113391 PMCID: PMC11322794 DOI: 10.2196/53427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 08/16/2024] Open
Abstract
Background Recently, the growing demand for pediatric sedation services outside the operating room has imposed a heavy burden on pediatric centers in China. There is an urgent need to develop a novel system for improved sedation services. Objective This study aimed to develop and implement a computerized system, the Pediatric Sedation Assessment and Management System (PSAMS), to streamline pediatric sedation services at a major children's hospital in Southwest China. Methods PSAMS was designed to reflect the actual workflow of pediatric sedation. It consists of 3 main components: server-hosted software; client applications on tablets and computers; and specialized devices like gun-type scanners, desktop label printers, and pulse oximeters. With the participation of a multidisciplinary team, PSAMS was developed and refined during its application in the sedation process. This study analyzed data from the first 2 years after the system's deployment. Unlabelled From January 2020 to December 2021, a total of 127,325 sedations were performed on 85,281 patients using the PSAMS database. Besides basic variables imported from Hospital Information Systems (HIS), the PSAMS database currently contains 33 additional variables that capture comprehensive information from presedation assessment to postprocedural recovery. The recorded data from PSAMS indicates a one-time sedation success rate of 97.1% (50,752/52,282) in 2020 and 97.5% (73,184/75,043) in 2021. The observed adverse events rate was 3.5% (95% CI 3.4%-3.7%) in 2020 and 2.8% (95% CI 2.7%-2.9%) in 2021. Conclusions PSAMS streamlined the entire sedation workflow, reduced the burden of data collection, and laid a foundation for future cooperation of multiple pediatric health care centers.
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Affiliation(s)
- Ziyu Zhu
- Big Data Center for Children’s Medical Care, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lan Liu
- Department of Anesthesiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, 20 Jinyu Avenue, Liangjiang New Area, Chongqing, 400014, China, 86 13983409393
| | - Min Du
- Department of Anesthesiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, 20 Jinyu Avenue, Liangjiang New Area, Chongqing, 400014, China, 86 13983409393
| | - Mao Ye
- Department of Anesthesiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, 20 Jinyu Avenue, Liangjiang New Area, Chongqing, 400014, China, 86 13983409393
| | - Ximing Xu
- Big Data Center for Children’s Medical Care, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Ying Xu
- Department of Anesthesiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, 20 Jinyu Avenue, Liangjiang New Area, Chongqing, 400014, China, 86 13983409393
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Parad RB. Non-sedation of the neonate for radiologic procedures. Pediatr Radiol 2018; 48:524-530. [PMID: 29550867 DOI: 10.1007/s00247-017-4002-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/01/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022]
Abstract
On Dec. 16, 2016, the U.S. Food and Drug Administration (FDA) released a warning regarding the potential neurotoxicity of anesthesia and sedation agents on the developing brain in children younger than 3 years and in women during their 3rd trimester of pregnancy. These concerns have relevance to the pediatric radiologist who must take into consideration how the child's state might impact image quality. In this review the author provides background on the special concerns in the potentially highest-risk group, pre-term and term neonates, and provides guidance and rationale for the avoidance of sedation in procedural imaging of the newborn.
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Affiliation(s)
- Richard B Parad
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis St., Rm. CWN418, Boston, MA, 02115, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA.
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Kaufman CS, James CA, Harned RK, Connolly BL, Roebuck DJ, Cahill AM, Dubois J, Morello FP, Morgan RK, Sidhu MK. Pediatric interventional radiology workforce survey: 10-year follow-up. Pediatr Radiol 2017; 47:651-656. [PMID: 28265695 DOI: 10.1007/s00247-017-3796-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/02/2016] [Accepted: 02/02/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric interventional radiology is a distinct subspecialty differing from both pediatric diagnostic radiology and adult interventional radiology. We conducted a workforce survey in 2005 to evaluate the state of pediatric interventional radiology at that time. Since then there have been many advancements to the subspecialty, including the founding of the Society for Pediatric Interventional Radiology (SPIR). OBJECTIVE To evaluate the current state of the pediatric interventional radiology workforce and compare findings with those of the initial 2005 workforce survey. MATERIALS AND METHODS We sent a two-part survey electronically to members of SPIR, the Society for Pediatric Radiology (SPR), the Society of Chairmen of Radiology in Children's Hospitals (SCORCH) and the Society of Interventional Radiology (SIR). Part 1 focused on individual practitioners (n=177), while part 2 focused on group practices and was answered by a leader from each group (n=88). We examined descriptive statistics and, when possible, compared the results to the study from 2005. RESULTS A total of 177 individuals replied (a 331% increase over the first study) and 88 pediatric interventional radiology (IR) service sites responded (a 131.6% increase). Pediatric IR has become a more clinically oriented specialty, with a statistically significant increase in services with admitting privileges, clinics and performance of daily rounds. Pediatric IR remains diverse in training and practice. Many challenges still exist, including anesthesia/hospital support, and the unknown impact of the new IR residency on pediatric IR training, although the workforce shortage has been somewhat alleviated, as demonstrated by the decreased mean call from 165 days/year to 67.2 days/year. CONCLUSION Pediatric interventional radiology practitioners and services have grown significantly since 2005, although the profile of this small subspecialty has changed and some challenges remain.
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Affiliation(s)
- Claire S Kaufman
- Department of Radiology, University of California San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA.
| | - Charles A James
- Department of Radiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Roger K Harned
- Department of Radiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Bairbre L Connolly
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Anne M Cahill
- Division of Interventional Radiology, Children's Hospital of Pennsylvania, Philadelphia, PA, USA
| | - Josee Dubois
- Department of Radiology, CU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Frank P Morello
- Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Robin K Morgan
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
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Saul D, Mong A, Biko DM. Pediatric Considerations in Computed Tomographic Angiography. Radiol Clin North Am 2015; 54:163-76. [PMID: 26654398 DOI: 10.1016/j.rcl.2015.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease in children comprises a diverse collection of diseases involving multiple organ systems. Abnormality in children is predominately congenital but also may be acquired. Although noninvasive vascular imaging modalities such as magnetic resonance angiography and ultrasound lack ionizing radiation, with improving technology and an increased focus on radiation dose reduction, computed tomographic angiography (CTA) continues to have a role in evaluating cardiovascular disease in pediatric patients. This review focuses on specific considerations of CTA that the radiologist or ordering provider should consider when imaging the pediatric cardiovascular system.
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Affiliation(s)
- David Saul
- Department of Radiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Andrew Mong
- Department of Radiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Hillenbrand CM, Reykowski A. MR Imaging of the Newborn: a technical perspective. Magn Reson Imaging Clin N Am 2012; 20:63-79. [PMID: 22118593 DOI: 10.1016/j.mric.2011.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article discusses neonatal magnetic resonance (MR) imaging and reviews equipment and procedures for MR-related transport, sedation, monitoring, and scanning. MR is gaining importance in the diagnosis and clinical management of critically ill, and often very low birth weight infants, so research is ongoing to make transport and examination safer and imaging more successful. Efforts are focused on integration of dedicated neonate MR scanners in neonatal intensive care units, improvements in incubator technology and handling, and more efficient use of scan/sedation time by choosing dedicated neonate coil arrays that improve the signal-to-noise-ratio and facilitate the choice of modern imaging techniques.
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Affiliation(s)
- Claudia M Hillenbrand
- Division of Translational Imaging Research, Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA
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Larsen R, Galloway D, Wadera S, Kjar D, Hardy D, Mirkes C, Wick L, Pohl JF. Safety of propofol sedation for pediatric outpatient procedures. Clin Pediatr (Phila) 2009; 48:819-23. [PMID: 19483136 DOI: 10.1177/0009922809337529] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Propofol sedation is used more frequently in pediatric procedures because of its ability to provide varying sedation levels. The authors evaluated all outpatient pediatric procedures using propofol sedation over a 6-year period. All sedation was provided by pediatric intensivists at a single institution. In all, 4716 procedures were recorded during the study period; 15% of procedures were associated with minor complications, whereas only 0.1% of procedures were associated with major complications. Significantly more major complications associated with propofol occurred during bronchoscopy (P = .001). Propofol administered by a pediatric intensivist is a safe sedation technique in the pediatric outpatient setting.
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Affiliation(s)
- Reagan Larsen
- Department of Pediatrics, Scott andWhite Memorial Hospital, Texas A&M University Health Science Center, Temple, Texas 76508, USA
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