1231: Developing a Post-Pediatric Sedation Discharge Score for Office-Based Procedures

Introduction: After any form of sedation procedure, from moderate sedation to general anesthesia the patient’s suitability for discharge should be assessed prior their discharge. Our discharge suitability is dependent upon 9 components, based upon the recommendations of several paper’s and our own practice. The aim of this study was to assess the inter-rater reliability of six of the 9 components between the recovery nurse and the research observer and assess if the discharge criteria as defined by the discharge score were being met. Methods: After IRB approval, informed parental consent/ assent if indicated pediatric and young adult scheduled for pediatric dental (PED) or oral surgical (OS) sedation procedures were recruited. There were 5 PED sedation options and 5 OS sedation options. All sedations were performed by an anesthesiologist or a pediatric intensivist in an office-based setting. The patients were observed by the research observer throughout the recovery process. Each component was scored every 5 minutes, 3 by the nurse and 6 by nurse and observer. The components include: Oxygen Use, RASS, Ambulation, Nausea, Pain, Vital Signs, Escort, PACU time and Procedure Issues. Each component had a score value of 0 to 4. Criteria scores of 0 or 1 were required for each component before the patient could be discharged. Patient demographics, procedure, sedation type and sedation outcomes were also collected. Results: We have recruited 59 patients, ages range from 4 to 19 years, 35 PED procedures. Sedatives used: Midazolam 37%, Fentanyl (31%), Propofol (61%), Sevoflurane (69%) and Morphine (34%). Discharge times range from 20 to 59 minutes. We have collected a total of 2442 study points. A score error of more than 1 between the raters occurred in 0.12% assessments. A score error of 1 between raters occurred in 1.6% assessments (mostly RASS). The median discharge score was 1 (range 0 - 6.5). There were 0% component scores of 2 or more (outside guidelines) at the time of discharge. Conclusions: There appears to be good inter-rater reliability for the score component using 2 raters. It appears to be appropriate for different sedation types. This score may be a useful tool for an intensivist run sedation program to ensure the appropriate discharge criteria for are met.