Factors associated with the use of procedural sedation during incision and drainage procedures at a children's hospital

Objective: The incidence of skin and soft tissue infections requiring incision and drainage has increased. Little evidence exists about the use of procedural sedation (PS) for these procedures in children. Our objective was to determine factors associated with the use of PS during incision and drainage procedures at a tertiary children's hospital. Methods: This was a nested cohort study that combined a retrospective medical record review with prospectively collected data for children 2 months to 18 years old who had an incision and drainage procedure performed at a children's hospital over a 1-year period. Procedural sedation was defined as the use of pharmacologic agents to alter patient consciousness. Patient, lesion (eg, size and induration), provider (eg, years of experience), and emergency department (eg, patient volume and wait time) factors were analyzed. Emergency department physicians were divided into tertiles by frequency of sedation (high/medium/low) to assess provider practice variation. χ² Analysis and multivariable logistic regression were used to identify factors associated with PS use. Results: Of the 215 enrolled patients, 95 (44.2%) received PS. Ninety (94.7%) of 95 sedated patients received ketamine as their primary sedation agent. On univariate analysis, emergency department volume, wait time, duration of illness, and provider experience were not associated with PS use. With multivariable regression, patient age, abscess size, and provider frequency of sedation were all independently associated with the decision to sedate. Conclusions: Patient age and abscess size are independent predictors of the use of PS for incision and drainage procedures. Provider practice patterns are also independently associated with PS use.