The landscape of pediatric procedural sedation in UK & Irish emergency departments; a PERUKI study

Study objective Approximately 250,000 children undergo pediatric procedural sedation (PPS) in UK & Irish emergency departments (ED) annually. PPS practice in our setting has not been described as fully as in other high income countries. We aimed to evaluate PPS in UK and Irish EDs. Methods Online survey distributed through Pediatric Emergency Research in the UK and Ireland (PERUKI) during June 2020. One respondent per ED completed the survey, including questions on agents, fasting, training and governance. Results are presented using descriptive statistics. Results 61/72 (85%) sites responded, of which PPS was performed in 50 (82%). Intravenous ketamine was the most common agent (43/50; 86%), followed by variable concentration nitrous oxide (13/50; 26%). Fasting practices varied widely across sites and agents: 24/45 (53.3%) of sites delivering ketamine/es-ketamine PPS required fasting compared to 2/13 (15.4%) before variable concentration nitrous oxide. 49/72 (68.1%) provided complete responses on training; internal training packages existed in under half (22/49, 44.9%). Most had a guideline (43/61; 70.5%) and documentation proforma (39/61; 63.9%). Databases existed in 24/61 (39.3%). Conclusion We have demonstrated widespread PPS use, but non-standardized practice. This leads to potential issues of risk and variability, highlighting a need for a UK and Ireland sedation package to standardize PPS practice and data collection, informed by international guidance and evidence. We propose development of a prospective ED sedation registry to facilitate data collection to support research within this area.