ED procedural sedation of elderly patients: is it safe?
Christopher S. Weaver MD
, Kevin M. Terrell DO, MS
, Robert Bassett DO
William Swiler DO
, Beth Sandford RN
, Sara Avery RN
, Anthony J. Perkins MS
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN, USA
Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA
Received 9 September 2009; revised 4 November 2009; accepted 15 December 2009
Objective: Emergency physicians routinely perform emergency department procedural sedation
(EDPS), and its safety is well established. We are unaware of any published reports directly evaluating
the safety of EDPS in older patients (≥65 years old). Many EDPS experts consider seniors to be at
higher risk. The objective was to evaluate the complication rate of EDPS in elderly adults.
Methods: This was a prospective, observational study of EDPS patients at least 65 years old, as
compared with patients aged 18 to 49 and 50 to 64 years. Physicians were blind to the objectives of this
research. The study protocol required an ED nurse trained in data collection to be present to record vital
signs and assess for any prospectively defined complications. We used American Society of
Anesthesiologists (ASA) physical status classification for systemic disease to evaluate and account for
the comorbidities of patients. We used the Fisher exact test for the difference in proportions across age
groups and analysis of variance for the differences in dosing across age and ASA categories.
Results: During the 4-year study, we enrolled 50 patients at least 65 years old, 149 patients aged 50 to
64 years, and 665 patients aged 18 to 49 years. Adverse event rates were 8%, 5.4%, and 5.2%,
respectively (P = .563). The at least 65 years age group represented a greater percentage of those with
higher ASA scores (P b .001). The average total sedative dose in the at least 65 years group was
significantly lower than the comparisons (P b .001).
Conclusions: This study demonstrated no statistically significant difference in complication rate for
patients 65 years or older. There was a significant decrease in mean sedation dosing with increased age
and ASA score.
© 2011 Elsevier Inc. All rights reserved.
In emergency departments (EDs), sedatives and/or
analgesics are frequently administered during brief, painful
procedures (eg, fracture or dislocation reduction, abscess
incision and drainage, wound care). This process is termed
emergency department procedural sedation (EDPS), and
various individual sedatives or a combination of sedatives
may be used [1-7].
When performed correctly, EDPS is a safe method to
minimize pain and awareness of uncomfortable procedures
[1-7]. The reported rates of adverse events in adults have
ranged from 5% to 20%. Although EDPS has been shown to
be safe for adults in general, we are unaware of any published
Presented: Poster presentation at 2009 SAEM Annual Meeting, May
2009, New Orleans, LA.
Corresponding author. Wishard Memorial Hospital, Indianapolis, IN
46202, USA. Tel.: +1 317 630 7276; fax: +1 317 6564216.
E-mail address: email@example.com (C.S. Weaver).
0735-6757/$ – see front matter © 2011 Elsevier Inc. All rights reserved.
American Journal of Emergency Medicine (2011) 29, 541–544