Abstract

OS1-131

Incidence and causes of adverse events in diagnostic radiological studies requiring anesthesia in the Wake-Up Safe registry

¹Uffman J, ²Khawaja A, ³Tumin D, ¹Tobias J
¹Nationwide Children's Hospital, Columbus, OH, United states; ²Nationwide Childrens Hospital, Columbus, OH, United states; ³Nationwide Childrens Hospital, Columbus, OH, United states

Introduction: General anesthesia or sedation can facilitate the completion of diagnostic radiological studies in children. However, the risk of adverse events (AEs) associated with sedation or anesthesia used for diagnostic imaging is an increasingly relevant concern in pediatrics as the demand for procedural sedation increases in children. We used a multi-center registry to evaluate the incidence, predictors, and causes of AEs when general anesthesia is provided for diagnostic radiological imaging.

Methods: De-identified data from 24 pediatric tertiary care hospitals participating in the Wake-Up Safe registry during 2010-2015 were obtained for analysis. Children 18 years of age and younger receiving general anesthesia for radiological procedures were identified using Current Procedural Terminology (CPT) codes indicating anesthesia used for diagnostic radiology, or CPT codes for specific diagnostic radiology services represented among reported AEs. The analysis of AEs included events associated with anesthetic care at magnetic resonance imaging (MRI) or computed tomography (CT) locations. Logistic regression was used to determine predictors of AE occurrence in cases with complete covariate data.

Results: We identified 160,185 anesthetics for diagnostic radiological examinations, compared to 74 AEs in MRI or CT locations (AE incidence of 0.05%). In multivariable analysis, AEs were more likely among patients with American Society of Anesthesiologists (ASA) status 4 compared to ASA 1 patients (OR=6.5; 95% CI=2.0, 21.6; p=0.002). The characteristics of patients with reported AEs are summarized in the Table. Nineteen AEs resulted in harm to the patient, while 28 AEs required escalation of care (unplanned hospital or intensive care unit admission). Anesthetic issues were the most common cause of AEs (n=49). Specific anesthetic issues included bradycardia, hypoxia, laryngospasm, vomiting, hypotension and provider errors (wrong dosage of anesthetics given to patient). However, AEs requiring escalation of care generally occurred because of the patient’s underlying disease (79%, vs 21% of AEs not requiring escalation of care; Fisher’s exact test p=0.007).

Conclusions: Anesthesia provided for pediatric radiological studies is very safe with an overall low AE incidence. However, the contribution of anesthetic issues to reported AEs suggests opportunities for further process improvement in this setting.

References:
1. Uffman JC, Tumin D, Raman V, Thung A, Adler B, Tobias JD. MRI Utilization and the Associated Use of Sedation and Anesthesia in a Pediatric ACO. J Am Coll Radiol. 2017;14:924-30.
2. Malviya S, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong JH, Tait AR. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth 2000;84:743-8.