The development of a Consensus Conference on Pediatric Procedural Sedation in the Emergency Department in Italy: from here where to?

Abstract

Background In Italy, as in many European countries, Pediatric Emergency Medicine is not formally recognized as a pediatric subspecialty, hindering nation-wide adoption of standards of care, especially in the field of procedural sedation and analgesia (PSA) in the Emergency Department (ED). For this reason PSA in Italy is mostly neglected or performed very heterogeneously and by different providers, with no reference standard. We aimed to describe the procedures and results of the first multidisciplinary and multi-professional Consensus Conference in Italy on safe and effective pediatric PSA in Italian EDs. Methods The preparation, organization and conduct of the Consensus Conference, held in Florence in 2017, followed the recommended National methodological standards. Professionals from different specialties across the country were invited to participate. Results Overall 86 recommendations covering 8 themes (pre-sedation evaluation, pharmacologic agents, monitoring, equipment and discharge checklists, training, non-pharmacologic techniques, the adult ED setting, impact on hospitalizations) were developed, taking into account the Italian training system and healthcare organization characteristics. Conclusion The results of the first multidisciplinary and multi-professional Consensus Conference in Italy are meant to provide up-to-date national guidance to improve the standard of care of children undergoing painful and stressful procedures in the ED. The recommendations will be periodically updated as new relevant evidence is published.

Incidence of Adverse Effects of Propofol for Procedural Sedation/Anesthesia in the Pediatric Emergency Population: A Systematic Review and Meta-Analysis

“…Pediatric emergency treatment is often accompanied by trauma or pain. Some painful or uncomfortable procedures may be necessary during emergency treatment, and emergency physicians are needed to provide safe and effective analgesia and sedation for children [ 1 , 2 ]. Moreover, local anesthesia and regional anesthesia together with appropriate safety procedures should be used for sedation to avoid aggravation of pain to ensure that the pediatric population will not suffer long-term or extra pain in emergency [ 3 ].…”

“Procedural sedation and analgesia in Italian pediatric emergency departments: a subgroup analysis in italian hospitals"

“…Our subgroup analysis could be a starter point for further studies and to implement current Italian recommendations [ 29 ] at institution levels, leading to the creation of national PSA guidelines, in order to guarantee an evidenced based, effective approach to pain and anxiety for all children seeking emergency care in Italy.…”

Quality Improvement Initiative Using Blended In Situ Simulation Training on Procedural Sedation and Analgesia in a Pediatric Emergency Department

“…Pediatric emergency medicine in Italy is not yet a formally recognized subspecialty, and specific training on PSA is not part of the core curriculum. [16][17][18] Thus, our hospital has been promoting symposia and workshops on mild to deep PSA for all of our pediatric emergency physicians (PEPs) since 2010. However, despite such training, only a few PEPs would perform deep sedation, even when patients are eligible for a procedure in the ED setting.…”

“…In North America, PSA is commonplace, 15 and in Europe, it has been gaining more and more acceptance in the last few years 16,17 . However, in Italy, many obstacles remain, especially regarding moderate and deep sedation.…”

“…Pediatric emergency medicine in Italy is not yet a formally recognized subspecialty, and specific training on PSA is not part of the core curriculum 16–18 . Thus, our hospital has been promoting symposia and workshops on mild to deep PSA for all of our pediatric emergency physicians (PEPs) since 2010.…”