Incidence of adverse events in paediatric procedural sedation in the emergency department

A systematic review and meta-analysis

M. Fernanda Bellolio, Henrique A. Puls, Jana Anderson, Waqas I. Gilani, Mohammad H Murad, Patricia Barrionuevo, Patricia J. Erwin, Zhen Wang, Erik P. Hess

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Objective and design: We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Setting: ED. Participants: Children. Interventions: Procedural sedation. Outcomes: Adverse events like vomiting, agitation, hypoxia and apnoea. Meta-analysis was performed with random-effects model and reported as incidence rates with 95% CIs. Results: A total of 1177 studies were retrieved for screening and 258 were selected for full-text review. 41 studies reporting on 13 883 procedural sedations in 13 876 children (=18 years) were included. The most common adverse events (all reported per 1000 sedations) were: vomiting 55.5 (CI 45.2 to 65.8), agitation 17.9 (CI 12.2 to 23.7), hypoxia 14.8 (CI 10.2 to 19.3) and apnoea 7.1 (CI 3.2 to 11.0). The need to intervene with either bag valve mask, oral airway or positive pressure ventilation occurred in 5.0 per 1000 sedations (CI 2.3 to 7.6). The incidences of severe respiratory events were: 34 cases of laryngospasm among 8687 sedations (2.9 per 1000 sedations, CI 1.1 to 4.7; absolute rate 3.9 per 1000 sedations), 4 intubations among 9136 sedations and 0 cases of aspiration among 3326 sedations. 33 of the 34 cases of laryngospasm occurred in patients who received ketamine. Conclusions: Serious adverse respiratory events are very rare in paediatric procedural sedation in the ED. Emesis and agitation are the most frequent adverse events. Hypoxia, a late indicator of respiratory depression, occurs in 1.5% of sedations. Laryngospasm, though rare, happens most frequently with ketamine. The results of this study provide quantitative risk estimates to facilitate shared decisionmaking, risk communication, informed consent and resource allocation in children undergoing procedural sedation in the ED.

Original languageEnglish (US)
Article numbere011384
JournalBMJ Open
Volume6
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Laryngismus
Meta-Analysis
Hospital Emergency Service
Pediatrics
Vomiting
Incidence
Ketamine
Apnea
Resource Allocation
Positive-Pressure Respiration
Masks
Informed Consent
Intubation
Respiratory Insufficiency
Observational Studies
Randomized Controlled Trials
Communication
Population
Hypoxia
9-deaza-9-(3-thienylmethyl)guanine

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Incidence of adverse events in paediatric procedural sedation in the emergency department : A systematic review and meta-analysis. / Bellolio, M. Fernanda; Puls, Henrique A.; Anderson, Jana; Gilani, Waqas I.; Murad, Mohammad H; Barrionuevo, Patricia; Erwin, Patricia J.; Wang, Zhen; Hess, Erik P.

In: BMJ Open, Vol. 6, No. 6, e011384, 01.06.2016.

Research output: Contribution to journalReview article

Bellolio, M. Fernanda ; Puls, Henrique A. ; Anderson, Jana ; Gilani, Waqas I. ; Murad, Mohammad H ; Barrionuevo, Patricia ; Erwin, Patricia J. ; Wang, Zhen ; Hess, Erik P. / Incidence of adverse events in paediatric procedural sedation in the emergency department : A systematic review and meta-analysis. In: BMJ Open. 2016 ; Vol. 6, No. 6.
@article{9faccf9713ac4d02a593531a4f1d8975,
title = "Incidence of adverse events in paediatric procedural sedation in the emergency department: A systematic review and meta-analysis",
abstract = "Objective and design: We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Setting: ED. Participants: Children. Interventions: Procedural sedation. Outcomes: Adverse events like vomiting, agitation, hypoxia and apnoea. Meta-analysis was performed with random-effects model and reported as incidence rates with 95{\%} CIs. Results: A total of 1177 studies were retrieved for screening and 258 were selected for full-text review. 41 studies reporting on 13 883 procedural sedations in 13 876 children (=18 years) were included. The most common adverse events (all reported per 1000 sedations) were: vomiting 55.5 (CI 45.2 to 65.8), agitation 17.9 (CI 12.2 to 23.7), hypoxia 14.8 (CI 10.2 to 19.3) and apnoea 7.1 (CI 3.2 to 11.0). The need to intervene with either bag valve mask, oral airway or positive pressure ventilation occurred in 5.0 per 1000 sedations (CI 2.3 to 7.6). The incidences of severe respiratory events were: 34 cases of laryngospasm among 8687 sedations (2.9 per 1000 sedations, CI 1.1 to 4.7; absolute rate 3.9 per 1000 sedations), 4 intubations among 9136 sedations and 0 cases of aspiration among 3326 sedations. 33 of the 34 cases of laryngospasm occurred in patients who received ketamine. Conclusions: Serious adverse respiratory events are very rare in paediatric procedural sedation in the ED. Emesis and agitation are the most frequent adverse events. Hypoxia, a late indicator of respiratory depression, occurs in 1.5{\%} of sedations. Laryngospasm, though rare, happens most frequently with ketamine. The results of this study provide quantitative risk estimates to facilitate shared decisionmaking, risk communication, informed consent and resource allocation in children undergoing procedural sedation in the ED.",
author = "Bellolio, {M. Fernanda} and Puls, {Henrique A.} and Jana Anderson and Gilani, {Waqas I.} and Murad, {Mohammad H} and Patricia Barrionuevo and Erwin, {Patricia J.} and Zhen Wang and Hess, {Erik P.}",
year = "2016",
month = "6",
day = "1",
doi = "10.1136/bmjopen-2016-011384",
language = "English (US)",
volume = "6",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "6",

}

TY - JOUR

T1 - Incidence of adverse events in paediatric procedural sedation in the emergency department

T2 - A systematic review and meta-analysis

AU - Bellolio, M. Fernanda

AU - Puls, Henrique A.

AU - Anderson, Jana

AU - Gilani, Waqas I.

AU - Murad, Mohammad H

AU - Barrionuevo, Patricia

AU - Erwin, Patricia J.

AU - Wang, Zhen

AU - Hess, Erik P.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Objective and design: We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Setting: ED. Participants: Children. Interventions: Procedural sedation. Outcomes: Adverse events like vomiting, agitation, hypoxia and apnoea. Meta-analysis was performed with random-effects model and reported as incidence rates with 95% CIs. Results: A total of 1177 studies were retrieved for screening and 258 were selected for full-text review. 41 studies reporting on 13 883 procedural sedations in 13 876 children (=18 years) were included. The most common adverse events (all reported per 1000 sedations) were: vomiting 55.5 (CI 45.2 to 65.8), agitation 17.9 (CI 12.2 to 23.7), hypoxia 14.8 (CI 10.2 to 19.3) and apnoea 7.1 (CI 3.2 to 11.0). The need to intervene with either bag valve mask, oral airway or positive pressure ventilation occurred in 5.0 per 1000 sedations (CI 2.3 to 7.6). The incidences of severe respiratory events were: 34 cases of laryngospasm among 8687 sedations (2.9 per 1000 sedations, CI 1.1 to 4.7; absolute rate 3.9 per 1000 sedations), 4 intubations among 9136 sedations and 0 cases of aspiration among 3326 sedations. 33 of the 34 cases of laryngospasm occurred in patients who received ketamine. Conclusions: Serious adverse respiratory events are very rare in paediatric procedural sedation in the ED. Emesis and agitation are the most frequent adverse events. Hypoxia, a late indicator of respiratory depression, occurs in 1.5% of sedations. Laryngospasm, though rare, happens most frequently with ketamine. The results of this study provide quantitative risk estimates to facilitate shared decisionmaking, risk communication, informed consent and resource allocation in children undergoing procedural sedation in the ED.

AB - Objective and design: We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Setting: ED. Participants: Children. Interventions: Procedural sedation. Outcomes: Adverse events like vomiting, agitation, hypoxia and apnoea. Meta-analysis was performed with random-effects model and reported as incidence rates with 95% CIs. Results: A total of 1177 studies were retrieved for screening and 258 were selected for full-text review. 41 studies reporting on 13 883 procedural sedations in 13 876 children (=18 years) were included. The most common adverse events (all reported per 1000 sedations) were: vomiting 55.5 (CI 45.2 to 65.8), agitation 17.9 (CI 12.2 to 23.7), hypoxia 14.8 (CI 10.2 to 19.3) and apnoea 7.1 (CI 3.2 to 11.0). The need to intervene with either bag valve mask, oral airway or positive pressure ventilation occurred in 5.0 per 1000 sedations (CI 2.3 to 7.6). The incidences of severe respiratory events were: 34 cases of laryngospasm among 8687 sedations (2.9 per 1000 sedations, CI 1.1 to 4.7; absolute rate 3.9 per 1000 sedations), 4 intubations among 9136 sedations and 0 cases of aspiration among 3326 sedations. 33 of the 34 cases of laryngospasm occurred in patients who received ketamine. Conclusions: Serious adverse respiratory events are very rare in paediatric procedural sedation in the ED. Emesis and agitation are the most frequent adverse events. Hypoxia, a late indicator of respiratory depression, occurs in 1.5% of sedations. Laryngospasm, though rare, happens most frequently with ketamine. The results of this study provide quantitative risk estimates to facilitate shared decisionmaking, risk communication, informed consent and resource allocation in children undergoing procedural sedation in the ED.

UR - http://www.scopus.com/inward/record.url?scp=84975297785&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975297785&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2016-011384

DO - 10.1136/bmjopen-2016-011384

M3 - Review article

VL - 6

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 6

M1 - e011384

ER -