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Procedural sedation in children with autism spectrum disorders in the emergency department

  • James J. Brown
    Correspondence
    Corresponding author at: Pediatric Emergency Medicine, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America.
    Affiliations
    Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
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  • James M. Gray
    Affiliations
    University of Minnesota Medical School, Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America
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  • Mark G. Roback
    Affiliations
    University of Minnesota Medical School, Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, 2450 Riverside Avenue, Minneapolis, MN 55454, United States of America
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  • Usha Sethuraman
    Affiliations
    Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
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  • Ahmad Farooqi
    Affiliations
    Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
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  • Nirupama Kannikeswaran
    Affiliations
    Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America
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Published:October 15, 2018DOI:https://doi.org/10.1016/j.ajem.2018.10.025

      Abstract

      Background and objectives

      Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED.

      Methods

      We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009–December 2016. Data were collected on children 1–18 years of age with ASD who were sedated in the ED.

      Results

      There were 6020 ED visits by children with ASD, 126 (2.1%) of whom received sedation. The most frequent indications for sedation were laceration repair (24.6%), incision and drainage (17.5%), diagnostic imaging (14.3%), and physical examination (11.9%). The most common sedatives used were ketamine (50.8%) and midazolam (50.8%). Ketamine was most commonly given intravenously (71.9%), while midazolam was usually given intranasally (71.9%). Procedures could not be completed in 4 (3.2%) patients, and adverse events were noted in 23 (18.3%) patients. Only four (3.2%) patients required supplemental oxygenation, and one received positive pressure ventilation.

      Conclusions

      Children with autism in the ED commonly received sedation; one in four of which were for non-painful diagnostic procedures or physical examination. Over one-third received sedation via a non-parenteral route for intended minimal sedation. Sedative medication dosing and observed adverse events were similar to those reported previously in children without ASD. Emergency providers must be prepared to meet the unique sedation needs of children with ASD.

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