118 - Assessing Sedation Using Patient-Centered Outcomes: Behavior, Safety, Efficacy

Purpose: To evaluate pediatric dental sedation success using patient-centered outcomes for behavior, safety, and treatment.

Methods: A cross-sectional retrospective cohort study used electronic health record data of children ages 24-60 months undergoing first-time sedations for dental treatment (2015-2020) at Nationwide Children’s Hospital, Columbus, OH. Outcomes were measured: behavior success was overall-visit Frankl score 3-4; safety success was maintenance of vital signs within 2 standard deviations of age- and gender-based norms; treatment success was completion of planned dental treatment. Overall success was defined as success in 2 of the 3 measures. Descriptive statistics and bivariate analyses compared medication regimens.

Results: Of 824 subjects (52.3% female, median age 36 months), behavior success was 49.0%, safety success was 79.5%, and treatment success was 62.1%. Overall success was 69.3%. Number of medications (excluding nitrous oxide) did not affect overall success (1 medication: 68.5%; ≥2 medications (e.g. midazolam+hydroxyzine): 75.6%, P=0.17). Subjects receiving intranasal midazolam (n=543) had lower overall success (66.5% versus 74.1%, respectively, P=0.05) and treatment success rates (63.2% versus 58.2%, P=0.23) than oral (n=189), although differences were not significant. However, behavior success and safety success were significantly different for intranasal versus oral administration (44.6% versus 59.8%, P<0.001; and 76.1% versus 85.7%, P=0.005).

Conclusion: Approximately 70% of sedations were successful. Combination regimens were neither associated with increased measure of success nor with impaired safety. All regimens exceeded 75% safety success. Intranasal midazolam proved significantly less effective for behavior and safety success than oral administration.