Sedation/anesthesia use for inpatient pediatric brain MRIs: National trends and outcomes.

BACKGROUND: Minimizing unnecessary sedation/anesthesia for pediatric brain MRI has been identified as an area for improvement. However, data on its use across a national sample of children's hospitals is lacking. OBJECTIVE: To understand patient demographics, clinical outcomes, hospital variation, and trends over time associated with sedation/anesthesia use for pediatric brain MRIs. METHODS: This retrospective cohort study utilized Pediatric Health Information System (PHIS) data for children < 18 years old who received an inpatient brain MRI from 2014 to 2024 (N = 215,377). Outcomes included the need for a repeat brain MRI, length of stay (LOS, in days), cost, and mortality. The likelihood of receiving sedation/anesthesia was modeled using Generalized Estimating Equations (GEE), clustered on hospital and adjusted for clinical and demographic factors. Outcomes were also modeled using GEEs. RESULTS: Sedation/anesthesia was used for 36% of children with no significant change over time. There was significant hospital variation in sedation/anesthesia use, ranging from 4.8% to 54.9%. Age, mental health diagnoses, and MRI type (contrast, limited) were associated with the likelihood of receiving sedation/anesthesia. Compared to no sedation/anesthesia, sedation/anesthesia use was associated with a lower likelihood of repeat MRI (1.7% vs. 5.6%, aOR 0.29, 95% CI: 0.25-0.34) and higher cost ($12,819 vs. $10,122, aRR 1.27, 95% CI: 1.13-1.42). There were no meaningful differences in LOS or mortality. CONCLUSION: There is currently wide variability in the use of sedation/anesthesia across children's hospitals, and its use was associated with lower repeat MRIs but higher costs. Identification of appropriate patients and MRI techniques may be strategies to reduce unnecessary sedation/anesthesia.