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Risk Factors for Sedation‐related Events During Acute Agitation Management in the Emergency Department
Author(s) -
Yap Celene Y. L.,
Taylor David McD.,
Kong David C. M.,
Knott Jonathan C.,
Taylor Simone E.
Publication year - 2019
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13826
Subject(s) - medicine , sedation , emergency department , odds ratio , confidence interval , incidence (geometry) , bradycardia , anesthesia , adverse effect , prospective cohort study , heart rate , blood pressure , physics , psychiatry , optics
Objective The objective was to describe the incidence, nature, and risk factors for adverse events ( AE s) among patients who received parenteral sedation for acute agitation in an emergency department ( ED ) setting. Methods We undertook a prospective observational study and a clinical trial of parenteral sedation for the management of acute agitation. We included agitated adult patients who required parenteral sedation from 2014 to 2017 in 12 Australian ED s, excluding those with incomplete information or aged under 18 years. The primary outcome was the number of patients who experienced at least one AE . Multivariable logistic regression was used to determine factors associated with AE s. Results A total of 904 patients were included in the analyses (62.3% male; median age = 34 years, range = 18 to 95 years). Of these, 144 (15.9%) patients experienced at least one AE . The most common AE s were oxygen desaturation (7.4%), airway obstruction (3.6%), bradycardia (1.9%), hypotension (1.7%), and prolonged QT c interval (1.3%). No deaths or serious AE s were reported. The following factors had an increased adjusted odds ratio ( OR ) for experiencing an AE : age 65 years and older ( OR = 2.8, 95% confidence interval [ CI ] = 1.2 to 7.2), more than one type of parenteral sedation administered within 60 minutes ( OR = 2.1, 95% CI = 1.4 to 3.1), and alcohol intoxication ( OR = 1.8, 95% CI = 1.2 to 2.6). Conclusions Sedation‐related AE s are common, especially respiratory events. Elderly patients, sedation with multiple sedatives within 60 minutes, and alcohol intoxication increased the risk.