Sedation of pediatric patients for minor laceration repair: Effect on length of emergency department stay and patient charges

Introduction: Sedating children can facilitate minor laceration repair by m inimizing physical and psychic discomfort. However, some clinicians are rel uctant to use sedation, in part because of concern about increased patient charges and fear that the emergency department (ED) stay will be prolonged. The purpose of this study was to determine the extent to which sedative us e during the repair of simple facial lacerations in children increased the length of ED stay and patient charges. Methods: This was a retrospective cohort study of 152 children with small, simple, facial lacerations. Patients with complex lacerations and those req uiring specialty consultation were excluded. Patients, at the discretion of the treating physician, received either intramuscular ketamine (n = 14), i ntranasal or rectal midazolam (n = 38), or no sedation (n = 100). Length of ED stay and the total patient charges were analyzed. Results: Groups were equal with respect to age, sex, and length of the woun d. The mean patient time in the ED, from placement in examination room to d ischarge, was significantly longer for those given ketamine (149 +/- 37 min utes) and midazolam (98 +/- 31 minutes) compared with those given no sedati on (82 +/- 28 minutes), Patient charges were also higher in those given ket amine ($695 +/- 172) or midazolam ($498 +/- 153) compared with those receiv ing no sedation ($390 +/- 86). Conclusions, The results of this study demonstrate that sedation with ketam ine or midazolam increases the length of ED stay compared with using no sed ation, However, the increased lengths of stay were modest, particularly for midazolam, Fear of prolonged recovery time should not dissuade clinicians from using either sedative for minor procedures. The patient charges are co nsiderably higher with both midazolam and ketamine, but they may not reflec t the actual cost of patient care.