SPS Plenary Session | May 22, 2019, 8:00 am | Joseph P. Cravero, MD
Dr. Cravero opened with a reference to an obscure baseball team that apparently wears red socks. He then went on to hit a home run by walking us through the evolution of the Pediatric Sedation State Score (PSSS). The story really begins with the Dartmouth Summit of Pediatric Sedation that led to the publication of Pride, Prejudice, and Pediatric Sedation: A Multispecialty Evaluation of the State of the Art. This publication highlighted the variability in the practice of pediatric sedation and the inadequacy of the tools we had available for the assessment of the overall quality and safety of sedation practice.
At the time, available tools looked mostly at depth of sedation, which is an important component of sedation evaluation but not necessarily linked to safety. To address this gap, Pediatric Sedation Research Consortium (PSRC) was born. From the PSRC there have been 30+ publications that have defined the current practice of pediatric sedation from the almost 60 well-organized sedation systems that contribute data. While serious adverse events were shown to be rare in these well-organized systems, and safety remains the backbone of all sedation programs, the data was not able to tell us much about the overall quality of the sedation provided.
The next leap came almost 10 years after the Dartmouth Summit. This summit of sedation experts in Baltimore led to the publication of Great Expectations – Defining Quality in Pediatric Sedation. The aim of the summit was to define quality in pediatric sedation using the six aims of quality as defined by the Institute of Medicine. One working group was charged with looking specifically at sedation effectiveness. Their goal was to develop a method to evaluate both the quality of the sedation provided plus the ability to complete the procedure. This led to an early project and publication of the Dartmouth Operative Conditions Scale.
Over time this tool was refined to the Pediatric Sedation State Score (PSSS) and the full article is available in the May 2017 issue of Pediatrics (Validation of the Pediatric Sedation State Scale). The PSSS seeks to define both the ability to get a procedure accomplished as well as to achieve a level of sedation that is not too light (leading to patient distress) and not too deep (requiring aggressive interventions to support the patient). Importantly, this scale is independent of the use of a particular sedation agent and can even incorporate non-pharmacologic strategies.
Although this tool has been well validated, the next step is to integrate the tool into widespread clinical practice. A tool is only effective if it can be deployed in the real world. It certainly could have implications for future research protocols comparing one sedation regimen to another. It also could be an important metric in sedation-related quality improvement projects. The PSSS is yet another stepping stone on the SPS journey to promote safe, high quality sedation for all children. We hope that you will review the PSSS and see how you might integrate it into your own sedation practice.
