Hill, J.M.; Vogel, D.Y.S.; Spek, B.; de Jong, C.J.; Krikken, J.B.; Veerkamp, J.S.J. Pediatric Sedation in Dutch Dental Clinics: The Influence of Guideline Modifications on Adverse Events. Dent. J.2024, 12, 66.
Hill, J.M.; Vogel, D.Y.S.; Spek, B.; de Jong, C.J.; Krikken, J.B.; Veerkamp, J.S.J. Pediatric Sedation in Dutch Dental Clinics: The Influence of Guideline Modifications on Adverse Events. Dent. J. 2024, 12, 66.
Hill, J.M.; Vogel, D.Y.S.; Spek, B.; de Jong, C.J.; Krikken, J.B.; Veerkamp, J.S.J. Pediatric Sedation in Dutch Dental Clinics: The Influence of Guideline Modifications on Adverse Events. Dent. J.2024, 12, 66.
Hill, J.M.; Vogel, D.Y.S.; Spek, B.; de Jong, C.J.; Krikken, J.B.; Veerkamp, J.S.J. Pediatric Sedation in Dutch Dental Clinics: The Influence of Guideline Modifications on Adverse Events. Dent. J. 2024, 12, 66.
Abstract
Abstract: Background: Dental fear and uncooperative behavior can hinder dental treatment quality. Pediatric Procedural Sedation and Analgesia (PPSA) is used to facilitate treatment when coping capacity is exceeded. Out-of-hospital PPSA has been associated with more adverse outcomes compared to hospital-based settings. Updated Dutch PPSA guidelines recommending two anesthesiologists and a ventilator during out-of-hospital PPSA have increased costs and raised concerns about the accessibility to specialized high quality dental care for children in the Netherlands. Aim: This study aims to investigate the impact of the updated 2017 guideline on the occurrence rate of adverse events during PPSA, as recorded in the anesthesia complication database of twelve participating Dutch dental clinics, with adjustments made for age, weight, and duration of treatment. Method: Data of 25,872 children treated at 12 dental clinics performing out-of-hospital PPSA between 1997 and 2019 were analyzed. Eligible children were aged 2-18 with ASA classification I and II. A logistic two-level mixed-effects model is used to estimate the updated guideline’s impact on adverse events. Results: In the final model we analyzed the data of 21,759 children in nine dental clinics. The OR of the occurrence rate of an adverse event adjusted for age, weight, and duration of treatment was 0.75 (95% CI 0.64 – 0.89) after the implementation of the updated guideline, compared to before the updated guideline. This outcome was significant with a P=0.001, indicating a protective effect. The average odds per clinic of having an adverse event was 0.04 with a 3.81% chance. Conclusion: Our findings demonstrate a significant reduction in adverse events after the implementation of the updated guideline and highlight the importance of adherence to evidence-based guidelines in improving patient safety and the quality of care provided during pediatric procedural sedation and analgesia in out-of-hospital dental clinics. Our study underlines the necessity of considering the complex underlying mechanisms that play a role in the development and implementation of evidence-based practice and safety initiatives on the occurrence of adverse events.
Keywords
Anesthesia; Dental; Dentistry; Pediatric; Evidence-Based Practice
Subject
Public Health and Healthcare, Public Health and Health Services
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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