Children's Hospital Colorado, Aurora, CO, USA.
Child Life Department, Children's Hospital Colorado, East 16th Ave, Aurora, CO, 1312380045, USA.
Pediatr Radiol. 2024 Oct;54(11):1919-1927. doi: 10.1007/s00247-024-06040-1. Epub 2024 Sep 18.
It can be challenging for children to cooperate for a magnetic resonance imaging (MRI) exam. General anesthesia is often used to ensure a high-quality image. When determining the need for general anesthesia, many institutions use a simple age cutoff. Decisions on the necessity for anesthesia are often left to schedulers who lack training on determination of patient compliance.
The study aimed to evaluate whether screening questions administered by certified child life specialists (CCLS) could successfully predict which children could complete an MRI without sedation.
This is a retrospective, institutional review board approved study. Data was collected as part of a quality improvement program, where a CCLS screened 4- to 12-year-old children scheduled for MRI scanning using a questionnaire. Parent responses to the screening questions, CCLS's recommendation for scheduling the MRI awake, start and end time for the MRI scan, and scan success were recorded. A predictive model for the CCLS's recommendation was developed using the child's age, estimated scan length, scan difficulty, and the parent's responses to the screening questions. The primary outcome measure was a successfully completed MRI not requiring additional imaging under anesthesia.
Of the 403 screened children, 317 (79%) were recommended to attempt the MRI without anesthesia. The median age of participants was 7 (IQR 4-17) years. Overall, 309 of 317 (97.5%) participants, recommended by the CCLS for the program, met the primary outcome of successful MRI completion on their first attempt. The multivariable regression model which included clinical information about the child's age, estimated scan length, scan difficulty, and four of the six parent screening questions had excellent performance (area under the curve = 0.89).
Information collected by the CCLS via screening along with the child's age, the estimated scan length, and difficulty can help predict which children are likely to successfully complete a non-sedate MRI.
对于儿童来说，配合磁共振成像（MRI）检查具有挑战性。通常使用全身麻醉来确保获得高质量的图像。在确定是否需要全身麻醉时，许多机构使用简单的年龄截止值。关于是否需要麻醉的决定通常由缺乏患者依从性评估培训的调度员做出。
本研究旨在评估由认证儿童生活专家（CCLS）进行的筛选问题是否能够成功预测哪些儿童可以在不镇静的情况下完成 MRI。
这是一项回顾性的机构审查委员会批准的研究。数据是作为质量改进计划的一部分收集的，其中 CCLS 使用问卷对计划进行 MRI 扫描的 4 至 12 岁儿童进行了筛查。记录了父母对筛查问题的回答、CCLS 建议进行清醒 MRI 扫描的情况、MRI 扫描的开始和结束时间以及扫描成功情况。使用儿童的年龄、估计的扫描长度、扫描难度以及父母对筛查问题的回答，为 CCLS 的建议开发了一个预测模型。主要结局指标为无需额外麻醉下成功完成的 MRI。
在接受筛查的 403 名儿童中，317 名（79%）被建议尝试不使用麻醉的 MRI。参与者的中位年龄为 7 岁（四分位距 4-17 岁）。总体而言，317 名（97.5%）参与者中，有 309 名（97.5%）根据 CCLS 的建议，在第一次尝试时成功完成了 MRI。包含儿童年龄、估计扫描长度、扫描难度以及六个父母筛查问题中的四个问题的多变量回归模型具有出色的性能（曲线下面积=0.89）。
CCLS 通过筛查收集的信息以及儿童的年龄、估计的扫描长度和难度可以帮助预测哪些儿童可能成功完成非镇静 MRI。
