MSK team achieves 0% sedation rate for pediatric MRI

Almost 2,000 children underwent musculoskeletal MRI over an eight-year stretch at the Hospital for Special Surgery, and not a single one of them needed sedation to get through the exam.

How did the orthopedic imagers pull that off? By bringing in a certified child life specialist to guide and comfort each patient before and/or during scan procedures.

HSS researchers described the accomplishment this week at the annual meeting of the Pediatric Orthopaedic Society of North America in Las Vegas.

Lead study author Jessica Heyer, MD, and colleagues made the finding after reviewing the records of all patients between 4 and 12 years of age who were imaged at Lerner Children’s Pavilion, the pediatric section of HSS, over the eight-year study period. 

In all, some 1,936 patients received a collective 2,319 MRI scans during that span. 

Heyer, a pediatric orthopedist and spine surgeon, touted the benefits of sedative-free MRI for young patients. 

“Without anesthesia, children can avoid the need for an IV, they don’t need to fast prior to the MRI, and they don’t need to extend their hospital-related experience to recover,” she says in coverage by HSS’s news operation. “And from a hospital perspective, it enables children to have an MRI even when an anesthesiologist is not available.”

The American Academy of Pediatrics approves 

HSS notes the importance of MRI patients holding very still while undergoing a scan, which can be difficult for kids—especially when the noisy, confining exam takes more than the usual 20 minutes. 

The hospital says sedation is used in more than 25% of cases nationally. 

Replacing sedation with child life specialists, the institution remarks, avoids potential medical risks, quickens return to regular life and “improves the overall efficiency of the MRI process, benefiting both families and care teams.”

Study co-author Melissa Collins, MS, a senior child life specialist at HSS, adds that the strategy is especially fitting for imaging children who have acute anxiety, sensory sensitivity or a history of negative medical experiences. 

“Children who’ve been told a procedure wouldn’t hurt and then were held down or experienced pain are less likely to trust medical professionals and medical environments,” Collins says. 

HHS cites guidelines from the American Academy of Pediatrics, which stresses that drug-free interventions like attention from child life professionals “must be considered as standard procedure in infants, children and adolescents undergoing MRI.”

Various steps, 1 destination: a completed MRI scan 

Among the specific interventions Heyer and colleagues reviewed were guided imagery, distraction strategies and caregiver involvement.

The most effective approach is “appropriate preparation based on the patient’s developmental age,” says child life specialist Collins. “It also helps to reiterate that nothing is going to touch them or hurt them.” 

HSS says Lerner Children’s Pavilion care teams always encourage one or both parents to accompany their child into the MRI suite. The teams also invite pediatric patients to bring a metal-free toy into the suite and equip the children with mirrored glasses, along them to see a reassuring adult for the duration of the procedure.

To celebrate their bravery, HSS adds, each child receives a small reward at the end of the exam.

“Our research demonstrates that, with proper preparation and support, we can transform a potentially stressful medical procedure into a positive experience for children,” Heyer comments. “By reducing the need for sedation, we’re not only reducing medical risks but also empowering children to actively participate in their healthcare journey, potentially making future medical encounters less intimidating.”

To catch up with prior research into sedation alternatives for children undergoing MRI, see:

• Gjaerde et al., Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis
• Uffman et al., MRI Utilization and the Associated Use of Sedation and Anesthesia in a Pediatric ACO 
• Staab et al., Child life specialists predict successful MRI scanning in unsedated children 4 to 12 years old