Intervention Makes it Easier for Children to Complete MRI Scanning Without Sedation

The scans require that patients remain motionless for extended periods. New findings revealed that a short-term, targeted intervention dramatically increases the likelihood that children as young as five years old will be able to undergo scanning without sedation.

That is promising news for children with sickle cell disease, who were the focus of this study. Patients with sickle cell disease frequently undergo brain and liver MRI scans to monitor for complications related to their disease or treatment. However, the blood disorder puts patients at increased risk for serious anesthesia-related complications; therefore, sedation is avoided when possible.

This study of 71 patients with sickle cell disease ages 5 through 12 found that children who completed the short preparation program prior to their MRI scan were eight times more likely to complete the scans without being sedated than patients of the same age who did not receive the preparation. The study’s findings were published online September 2012 in the journal Pediatric Radiology.

The intervention implemented by the Child Life Program at St. Jude Children’s Research Hospital (Memphis, TN, USA) involves educating patients and families about exactly what to expect during an MRI, assigning patients jobs to focus on during the scans and working to identify strategies to help them remain motionless during the scanning process. “Some patients chose to listen to music or to squeeze a ball to help them remember not to move,” said Dr. Katherine Cejda, a St. Jude Child Life specialist and the study’s first author. “Some patients had the option of watching movies or having parents or other adults in the room with them during the test.”

This study is the first designed to determine the effectiveness of this approach and the first to focus on children with sickle cell disease. Dr. Cejda reported that similar programs are used by child life specialists throughout the United States to help prepare children for MRI scanning and other medical procedures. The article’s senior author, Jane Hankins, MD, an associate member of the St. Jude department of hematology, reported that avoiding sedation reduces the risk to the patients, especially those with sickle cell disease.

Sickle cell disease is caused by a mutation in the gene for assembling hemoglobin. Hemoglobin is the protein red blood cells use to transport oxygen throughout the body. While red blood cells are typically pliable discs, the inherited error results in red blood cells becoming stiff and assuming a banana shape that can trigger intense pain and lead to organ damage. Dr. Hankins noted that the disease also makes anesthesia riskier.

General anesthesia can lead to a decrease in temperature, blood oxygen levels, and dehydration. In patients with sickle cell disease, dehydration can result in a painful and hazardous accumulation of sickled cells. Patients can end up hospitalized, occasionally in the intensive care unit, for treatment of severe pain or acute chest syndrome, a pneumonia-like illness, according to Dr. Hankins. To reduce that risk, a sickle cell patient scheduled for anesthesia is hospitalized overnight to receive extra fluids and possibly a blood transfusion.

The combination of factors creates problems and added risk for the patient. It also adds to health care costs. Whereas no family ever pays St. Jude for the care their child receives, controlling costs remains important to the hospital. The program could also be adopted by other health care institutions worldwide to help manage cost. The intervention is now routinely offered to all St. Jude patients undergoing MRIs. Dr. Cejda noted that the program has been used to help children as young as age four complete scans without sedation. “This preparation program offers a real advantage to patients,” Dr. Hankins added.

The study included children scheduled for brain or liver MRI scans that usually last 30 to 60 minutes. Researchers reported that 30 of the 33 children, or 91%, in the intervention group underwent successful MRI scans without sedation. That compares to 71%, or 27 of 33 patients, who did not participate in the program prior to undergoing MR scanning without sedation.

St. Jude Children’s Research Hospital has played a pivotal role in pushing overall US pediatric cancer survival rates from 20%-80%. No family ever pays St. Jude for the care their child receives.

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