Background:

In Germany, approximately 800,000 people live with intellectual disabilities, many of whom also have severe physical impairments and an increased risk of comorbidities and premature mortality. A substantial proportion is unable to cooperate adequately during medical examinations, making sedation necessary to enable essential diagnostics. However, data on the frequency, indications, and outcomes of sedation-assisted diagnostic procedures in this population are limited.

Research questions:

This study aimed to determine how often patients with intellectual and/or complex multiple disabilities required sedation for diagnostic procedures at a Medical Center for Adults with Disabilities (MZEB), to identify the indications and methods of sedation, and to assess the clinically relevant findings obtained.

Method:

A retrospective secondary analysis of anonymized medical records was conducted, including paper files and electronic health records from the hospital information system. All cases involving diagnostic procedures performed under sedation between January 2021 and November 2023 at a cooperating MZEB were included. Data were entered into Excel and analyzed descriptively using SPSS version 29.

Results:

During the observation period, 807 patients were treated at the MZEB; 112 patients (13,9%) underwent at least one sedation-assisted diagnostic procedure due to insufficient cooperation. Most procedures were planned (94,6%) and commonly triggered by newly emerging symptoms (75,0%). Ultrasound (54,5%) and CT-Scan (43,8%) were the most frequent procedures. Previously unknown pathological findings were identified in 69,6%. As a consequence, further diagnostic workup was initiated in 28,2%, new medication prescribed in 57,7 % and structured follow-up care planned in 51,3% of patients. No severe adverse events related to sedation were observed.

Conclusions:

Sedation-assisted diagnostics enabled the detection of clinically relevant findings in a substantial proportion of non-cooperative patients in a specialized outpatient setting. When carefully indicated and ethically considered, sedation represents a safe and valuable tool to ensure equitable access to medical diagnostics for adults with intellectual and complex disabilities.

Points for discussion:

1. How sedation-assisted diagnostics contribute to equal access to medical care for adults with intellectual and complex disabilities

2. The high proportion of newly identified pathological findings and its implications for routine diagnostic strategies in this population.

3. The role of specialized outpatient care settings in the quality and safety of sedation-assisted diagnostics in adults with intellectual and complex disabilities.