Paediatric procedural sedation and or analgesia in the emergency unit: A cross-sectional study of practice at Mulago National Referral Hospital

Abstract

Background: Paediatric Procedural Sedation and or Analgesia (PPSA) is the recommended standard of practice for children undergoing painful and distressing procedures outside the operating room, however, globally practice may vary. In Sub-Saharan Africa, data on the practice of PPSA is lacking. This study aimed to determine the current practice and outcomes of PPSA in the Accident & Emergency unit of Mulago National Referral Hospital to inform future standardization of care. Methods: This cross-sectional study, undertaken in 2024, collected data on children ≤ 17 years of age, scheduled for a procedure under sedation and/or analgesia, using specifically designed and pretested observational checklists, including patient demographics, pre-procedure assessment and preparation, intra-procedural and post-procedural care, average sedation scores attained, pain control and adverse events observed. Data was coded and stored using Epi-data (v4.6) and analysed using Stata (v16.0). Analysis was undertaken to determine the number of sedations/analgesia done, the baseline PPSA practice and immediate outcomes. Results: 183 children undergoing procedures at A&E were recruited for the study. Majority were male, 104/183 (56.8%) and the median age (IQR) was 8 (4-12) years. Most procedures performed were orthopaedic, 149/183 (81.4%). Only 15/183 (8.2%) children got both sedation and analgesia, 4/183 (2.2%) got sedation only while 164/183 (89.6%) got analgesia only. Propofol was the most used sedative while lignocaine + paracetamol was most used analgesia. Most children, 92/183 (50.3%) had pain scores ≥8 and adverse events occurred in 6/15 (40%) of the children who got both sedation and analgesia. Conclusion: This study reveals that PPSA practice in this setting is largely divergent from recommended standards, highlighting a great need for training of providers and setting guidelines to standardize care.