A new screening tool can identify pediatric patients who could potentially undergo an MRI without anesthesia, according to a study published in the Journal of the American College of Radiology.
“Sedation and general anesthesia carry risks of adverse events, including drug error, unanticipated hospitalization, respiratory adverse events (hypoxemia, laryngospasm, aspiration, respiratory arrest) and cardiac compromise (arrhythmias, hypotension, cardiac arrest) as well as emergence delirium and maladaptive behavior in the postanesthetic period,” wrote author Arlyne Thung, MD, of the department of anesthesiology and pain medicine at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues. “Therefore, attempting an MRI examination without pharmacological intervention may be ideal, although not always possible.”
The screening tool, known as the modified Yale Preoperative Anxiety Scale (mYPAS), helps specialists predict which pediatric patients could successfully complete the MRI without anesthesia. To test mYPAS, 80 patients over the age of 5 who were scheduled for MRI with anesthesia from 2015 to 2016 were asked to participate in simulation-based training. Certified child life specialists carried out the mYPAS assessment before and after practice MRI sessions.
A mYPAS score of more than 30 indicates anxiety. Overall, the patients’ average mYPAS scores improved from 31 before the training session to 27 after the training session. Just 14 percent of patients still required anesthesia to complete the MRI after their training sessions. The area under the curve for the tool’s ability to predict MRI completion without anesthesia was 0.81.
“We found that the mYPAS was a quick and useful screening tool to identify which pediatric patients would benefit from simulation-based training with a mock MRI scanner versus those who would not,” the authors wrote.
Thung et al. also noted that presimulation mYPAS scores were higher for patients who ultimately could not complete the MRI without anesthesia. Those patients also had higher scores after the simulation, suggesting that there was “minimal benefit” for such patients. If a patient had a presimulation score of more than 33, that indicated they would need the anesthesia no matter what.
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