Comparison of Procedural Sedation Outcomes in Children With and Without Autism Spectrum Disorder

OBJECTIVE Children with autism spectrum disorder (ASD) often have comorbidities predisposing them to higher risk for sedation-related adverse events (AEs). Our objective was to compare sedation-related AEs in children with and without ASD.PATIENTS AND METHODS We conducted a multicenter study of children aged 3-18 years with and without ASD who underwent sedation outside the operating room from May 1, 2022, to April 30, 2023, using the Pediatric Sedation Research Consortium database. The primary exposure was ASD diagnosis. We compared AEs in children with and without ASD after matching for age, sex, procedure, and American Society of Anesthesiologists classification.RESULTS Of 64 708 children analyzed, 4421 (6.8%) had an ASD diagnosis. A higher proportion of children with ASD were male (75.4% vs 54.7%), obese (6.0% vs 2.9%), and had a comorbid condition (93.5% vs 40.3%). Matched analysis showed no significant difference in critical AEs (odds ratio [OR], 0.63; 95% CI, 0.23-1.49). However, children with ASD had greater odds of high risk (OR, 1.52; 95% CI, 1.26-1.83) and low-risk AEs (OR, 1.39; 95% CI, 1.25-1.55) compared with children without ASD. Specifically, children with ASD had greater odds of hypoxia (OR, 1.31; 95% CI, 1.10-1.56) and complete (OR, 1.89; 95% CI, 1.27-2.81) or partial (OR, 1.43; 95% CI, 1.25-1.63) airway obstruction.CONCLUSIONS Children with ASD are at a higher risk for sedation-related airway AEs and significant respiratory interventions, although the incidence of critical AEs was low.