SPS Plenary Session | May 20, 2019, 1:30 pm | Pradip Kamat, MD
The Pediatric Sedation Research Consortium (PSRC) has collected data on over 450,000 sedations from 2007-2018. Dr. Pradip Kamat’s presentation, “Trends in PSRC Sedation”, was an informative and, dare I say, entertaining (who will ever forget the immortal line, “any gorilla can push propofol”?) review of information from this valuable dataset. Dr. Kamat described to us how sedation practice in the groups contributing to the PSRC have behaved over time.
The PSRC currently collects data from over 50 participating institutions that access the database through their institutional membership in the Society for Pediatric Sedation. The intent of this data collection is to promote improvements in pediatric sedation practice by sharing prospective observational outcome data. Single institution sedation research studies are hampered by their general reliance on retrospective data and small sample sizes which are underpowered to comment on safety. The PSRC, on the other hand, has large numbers from multiple practices which can overcome those disadvantages. There are some caveats to PSRC data interpretation. Drug doses or timing, sedation depth, intra-procedure hemodynamics, recovery, and sedation quality are not recorded. Additionally, safety data may not extrapolate to practices outside the PSRC’s contributing groups. Despite these caveats, this represents a valuable source of data on sedations.
The talk focused on four main areas: demographics, providers and procedures, adverse events, and medications. Over the eleven years studied, while some things stayed the same, some significant changes were apparent. The demographics of our patients have not changed much over time, with the majority falling within the ages of 1-13 years. ASA physical status classification distribution has also been consistent, with the great majority ASA 1 and 2. In contrast to the stability of the basic patient mix, the practitioners providing sedation have changed slightly over the course of the 11 years. The largest group of physicians remains the intensive care physicians, with emergency medicine as the second largest group. Over the course of the study period, hospital medicine has markedly increased its representation in the database, and dentistry has slightly but steadily increased as well. While the largest volume of cases for which sedation is provided remains radiology, hematology-oncology and dental procedures have increased in numbers over time.
Medications used have seen the most dramatic shifts, with the gradual diminishment of pentobarbital and chloral hydrate over time. Propofol remains the most popular medication used by PSRC participants, with an increase over time of propofol in combination with other medications such as fentanyl and ketamine. Interestingly, while propofol is far and away the most-utilized medication by most physicians, dentists who contribute to PSRC use far more fentanyl and midazolam than their colleagues in other specialties.
The incidence of serious adverse events has remained low (~2%) and steady over the time period investigated. Airway obstruction was by far the most common, with airway repositioning representing the most common action taken.
All in all, while this dataset has limitations which are listed above, Dr. Kamat reviewed the depth and potential power of this data collection methodology as we move forward into the future of Big Sedation Data.