Procedural Sedation in the Community Emergency Department: Initial Results of the ProSCED Registry

Sacchetti, Alfred; Senula, Gary; Strickland, J. H.; Dubin, Reva

doi:10.1111/j.1553-2712.2007.tb00369.x

Cited by 67 publications

(80 citation statements)

References 24 publications

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“…A sensitivity analysis was performed to assess the impact of individual studies and low-quality studies on the results of the meta-analysis. This was done by removing one RCT at a time from the Bag-mask valve ventilation Death < 93% 4 Use of an oral airway Disability < 92% 2,20 Transient apnea Hospital admission < 90% 3,5,6,12,15,[22][23][24]29,33,34,[40][41][42][43] Vomiting without aspiration Prolonged ED stay Transient hypotension Intubation Myoclonus…”

Section: Study Protocolmentioning

confidence: 99%

“…1,4,33 However, given that most series rely on voluntary physician reporting, it is possible that reporting bias led to underreporting of AEs. The extent to which this bias may influence the literature on PS is unknown.…”

Section: Limitationsmentioning

confidence: 99%

“…1 At present, the choice of agent depends largely on local practice patterns and practitioner comfort. 1,3,4 Registry data from the United States and Canada indicate that propofol is used in 25% to 84% of PS episodes, 1,3,4 and midazolam in 15% to 42%. 1,3,4 Ketamine, etomidate, ketafol, and methohexital are used less commonly in adults, and ketamine and etomidate are associated with minor yet bothersome side effects (emergence and myoclonus, respectively), which may limit their widespread use in this patient population.…”

mentioning

confidence: 99%

“…1,3,4 Registry data from the United States and Canada indicate that propofol is used in 25% to 84% of PS episodes, 1,3,4 and midazolam in 15% to 42%. 1,3,4 Ketamine, etomidate, ketafol, and methohexital are used less commonly in adults, and ketamine and etomidate are associated with minor yet bothersome side effects (emergence and myoclonus, respectively), which may limit their widespread use in this patient population. 2,[5][6][7][8][9] Cohort studies, registry data, and small randomized controlled trials (RCTs) suggest that propofol and midazolam are safe and effective for use in PS.…”

mentioning

confidence: 99%

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Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Hohl

Sadatsafavi²,

Nosyk³

et al. 2008

Academic Emergency Medicine

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Objectives: To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting. Methods:The authors conducted a systematic review of randomized controlled trials (RCTs) and observational studies reporting the use of either midazolam and ⁄ or propofol for adult PS in the emergency department (ED). A systematic search strategy was developed and applied to six bibliographic reference databases. Three emergency medicine journals, the Canadian Adverse Drug Reaction Newsletter, and conference proceedings were hand-searched. Retrieved articles were reviewed and data were abstracted using standardized data collection. Trial quality was assessed using the Jadad score. The outcomes assessed were the proportion of patients with AEs and the pooled mean difference in the proportion of patients with successful PS.Results: Of 229 articles identified, 28 met the inclusion criteria for the analysis of AEs. Only one major AE to PS was found, resulting in no statistically significant difference in the proportion of major AEs between agents. Four studies were RCTs that met the inclusion criteria for the analysis of clinical effectiveness. Two trials met criteria for good quality. The RCTs enrolled between 32 and 86 patients, and the most common indications for PS were orthopedic reductions and cardioversions. There was a nonsignificant difference in the proportion of patients with successful PS in favor of propofol (effect difference 2.9%, 95% confidence interval (CI) = -6.5 to 15.2). Conclusions:The authors found no significant difference in the safety profile and the proportion of successful PS between midazolam and propofol for adults in the ED.ACADEMIC EMERGENCY MEDICINE 2008; 15:1-8 ª

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Section: Study Protocolmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Hohl

Sadatsafavi²,

Nosyk³

et al. 2008

Academic Emergency Medicine

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“…14 Even though growing fracture is uncommon (2% of all fractures), its detection is important because of the risk of brain hernia if left undiscovered. 13, [15][16][17] Rapid identification can lead to successful repair with a rather simple neurosurgical intervention. 18 Controversies exist regarding the proper use of radiology for minor head trauma in children.…”

mentioning

confidence: 99%

Derivation and validation of a clinical decision rule to identify young children with skull fracture following isolated head trauma

Gravel

Gouin

Chalut

et al. 2015

CMAJ

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A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Norii

Kimura²,

Homma³

et al. 2018

Acute Medicine & Surgery

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Aim Worldwide, health‐care providers carry out procedural sedation and analgesia (PSA) in the emergency department. However, training opportunities are limited in many Asian countries, including Japan. We formed an educational group consisting of board‐certified emergency physicians in the USA and Japanese physicians and developed a PSA training module. The aims of our study were to demonstrate the effectiveness of training and to describe PSA practice in Japan. Methods We undertook a pretest of PSA knowledge questions and a retest immediately after the training intervention. We also carried out a survey and asked about participants' PSA practice. The training module consisted of four didactic hours and three simulation and skills laboratory hours. Results of all pre‐ and post‐intervention knowledge questions were analyzed with McNemar's test, and overall scores were analyzed with a paired t‐test. Results One hundred and forty‐four health‐care providers including 123 physicians, 16 nurses, two pharmacists, and three medical students participated in the training. A total of 119 (83%) completed both the pre‐ and post‐intervention knowledge questions. Before the training, participants scored an average 66% (63%–69%) on the written knowledge test. After the intervention, participants showed significant improvement on the knowledge test (improvement 17%; 14%–20%). Among participants who answered the practice survey, 121 (88%) have undertaken PSA. Only 14 (12%) participants always or often use a continuous capnography for PSA. Only 32 (26.4%) participants undertook pre‐PSA systematic evaluation. Conclusion Our educational intervention successfully increased participants' knowledge. Only the minority of health‐care providers use capnography routinely for PSA, and pre‐PSA evaluation is not commonly carried out.

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Procedural Sedation in the Community Emergency Department: Initial Results of the ProSCED Registry

Abstract: Community emergency physicians deliver safe and effective PSA over a wide variety of ages and procedures while using a broad selection of agents.

Cited by 67 publications

References 24 publications

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Safety and Clinical Effectiveness of Midazolam versus Propofol for Procedural Sedation in the Emergency Department: A Systematic Review

Derivation and validation of a clinical decision rule to identify young children with skull fracture following isolated head trauma

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

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