Rationale and Objectives: In pediatric imaging, particularly MRI, sedation is often
necessary to obtain diagnostic quality imaging and avoid motion artifact. Prior studies
have suggested an increased risk of neurocognitive delay from repeated anesthesia
exposure in childhood. We aim to quantify patient and imaging-specific factors
associated with successful pediatric scans without anesthesia and to evaluate labor cost
savings associated with our institutional Scan Without Anesthesia Program (SWAP).
Materials and Methods: Patients who participated in SWAP between Oct 2019- Apr 2022
were identified from Child Life Specialist records. Chart review was conducted to obtain
sociodemographic and clinical information. Radiology database was used to obtain scan
duration, modality/body part of examination, and administration of contrast. Mann-
Whitney U and Chi-Square tests were used for univariate analysis of factors associated
with success. Backward elimination multivariate logistic regression was used to evaluate
independent contributions to success. Associated hospital labor cost savings were
estimated using the average hourly rate of labor costs for each specialist compiled
through public records with hourly rates based on a job code’s mid- tier rate.
Results: Of 731 patients, 698 had successful and 33 had unsuccessful scans (95% success
rate). In univariate analysis, older age, female sex, absence of developmental delay, and
administration of contrast were significantly associated with successful scans.
Multivariate analyses revealed that older age, female sex, and absence of developmental
delay were significant independent factors lending toward success. Imaging-related
factors were not associated with outcome in multivariate analysis. Estimated labor cost
savings were $139,367.80 per year for the medical center.
Discussion: SWAP had an overall success rate of 95%. Older age, absence of
developmental delay, and female sex were independently significantly associated with
successful outcome. Cost analysis reveals substantial labor cost savings to the institution
compared with imaging under anesthesia.
Acknowledgements: The authors wish to acknowledge and thank Devin Dixon, CRA and
Christopher Lam, BS of Radiology Operations for their assistance with anesthesia
procedural codes and cost analysis in this paper.