Serious Adverse Events in Pediatric Procedural Sedation Before and After the Implementation of a Pre-Sedation Checklist
Authors Librov S, Shavit I
Received 15 May 2020
Accepted for publication 26 June 2020
Published 17 July 2020 Volume 2020:13 Pages 1797—1802
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Robert B. Raffa
Simona Librov,1 Itai Shavit2
1Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel; 2Emergency Department, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
Correspondence: Itai Shavit POB 274, Kibutz Maayan Tzvi, 3080500, Israel
Objective: Procedural sedation is considered by the Joint Commission on Accreditation of Healthcare Organizations as a high-risk procedure when performed in the emergency department (ED). A pre-sedation checklist is a set of items checked before any sedation. We evaluated the impact of a pre-sedation checklist on the rate of serious adverse events (SAE) in a pediatric ED.
Methods: We conducted a retrospective study comparing the rate of SAE in children treated with the combination of ketamine and propofol before and after the implementation of a pre-sedation checklist. The before-and-after periods lasted from 1.1.2013 to 30.6.2016 and from 1.7.2016 to 30.6.2019, respectively. Patient data were extracted from the electronic medical records using an integrated business intelligence information system.
Results: The before-and-after cohorts included 1349 and 1846 patients, respectively. The two groups were similar with regard to age, sex, length and type of procedure, medications dosage, and level of physicians’ training. A total of 183/1349 (13.5%) and 420/1846 (22.7%) SAE were recorded during the before-checklist and after-checklist periods, respectively (p< 0.0001). The rates of laryngospasm, apnea, and oxygen saturation ≤ 90% at the before-and-after checklist periods were 9/1349 (0.6%) and 30/1846 (1.6%); p< 0.05, 48/1349 (3.5%) and 77/1846 (4.2%); p=0.37, and 123/1349 (9.1%) and 312/1846 (16.9%); p< 0.0001, respectively. All the SAE were successfully managed by the emergency physicians and no patient required hospitalization due to a SAE.
Conclusion: In this large cohort of ED children who underwent deep sedation, the administration of a pre-sedation checklist was not associated with a reduction in SAE rate.
Keywords: sedation, checklist, adverse events, pediatric
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]