Uspal Neil G, Klein Eileen J, Tieder Joel S, Oron Assaf P, Simon Tamara D
Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
Hosp Pediatr. 2015 Apr;5(4):185-92. doi: 10.1542/hpeds.2014-0115.
Little is known about procedural sedation use for anxiety and pain associated with skin and soft tissue infections (SSTIs) requiring incision and drainage (I&D). Our objectives were therefore (1) to characterize the use of procedural sedation use for SSTI I&D procedures in pediatric emergency departments (EDs), (2) to compare the frequency of procedural sedation for I&D across hospitals, and (3) to determine factors associated with use of procedural sedation for I&D.
We performed a retrospective cohort study of pediatric EDs contributing to the Pediatric Health Information Systems database in 2010. Cases were identified by primary International Classification of Diseases, 9th revision, Clinical Modification procedure codes for I&D. We used descriptive statistics to describe procedural sedation use across hospitals and logistic generalized linear mixed models to identify factors associated with use of procedural sedation.
There were 6322 I&D procedures, and procedural sedation was used in 24% of cases. Hospital-level use of procedural sedation varied widely, with a range of 2% to 94% (median 17%). Procedural sedation use was positively associated with sensitive body site, female gender, and employer-based insurance, and negatively associated with African American race and increasing age. Estimates of hospital-level use of procedural sedation for a referent case eliminating demographic differences exhibit similar variability with a range of 5% to 97% (median 34%).
Use of procedural sedation for SSTI I&D varies widely across pediatric EDs, and the majority of variation is independent of demographic differences. Additional work is needed to understand decision-making and to standardize delivery of procedural sedation in children requiring I&D.
对于因皮肤和软组织感染（SSTIs）需要切开引流（I&D）而进行的焦虑和疼痛相关的程序性镇静使用情况，我们了解甚少。因此，我们的目标是：（1）描述儿科急诊科（EDs）中SSTI I&D程序的程序性镇静使用情况；（2）比较各医院I&D的程序性镇静使用频率；（3）确定与I&D程序性镇静使用相关的因素。
我们对2010年向儿科健康信息系统数据库贡献数据的儿科急诊科进行了一项回顾性队列研究。通过国际疾病分类第9版临床修订本中I&D的主要程序编码来识别病例。我们使用描述性统计来描述各医院的程序性镇静使用情况，并使用逻辑广义线性混合模型来识别与程序性镇静使用相关的因素。
共有6322例I&D程序，其中24%的病例使用了程序性镇静。各医院程序性镇静的使用情况差异很大，范围为2%至94%（中位数为17%）。程序性镇静的使用与敏感身体部位、女性性别和基于雇主的保险呈正相关，与非裔美国人种族和年龄增长呈负相关。消除人口统计学差异后的参照病例的医院层面程序性镇静使用估计值显示出类似的变异性，范围为5%至97%（中位数为34%）。
儿科急诊科中SSTI I&D的程序性镇静使用情况差异很大，且大部分差异与人口统计学差异无关。需要开展更多工作来了解决策过程，并规范需要I&D的儿童的程序性镇静实施。
