Key result
Pre-procedural prediction model identifies high colonoscopy sedation requirements with an AUC of 0.76.
Why the study?
Factors associated with increased sedation requirements during outpatient colonoscopy were not well defined, necessitating a predictive model for higher sedation doses.
Does a prediction model using pre-procedural variables identify patients requiring high sedation doses during outpatient colonoscopy?
Observational (n=5,000)
No
Does a prediction model using pre-procedural variables identify patients requiring high sedation doses during outpatient colonoscopy?
A predictive model using pre-procedural variables can identify patients likely to require high sedation doses during outpatient colonoscopy with an AUC of 0.76.
Answers are grounded in this paper and cite their sources.
May support pre-procedural sedation risk stratification; leaves open prospective validation before clinical adoption.
AIM: To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during colonoscopy. METHODS: A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at St. Paul's Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of sedatives. Potential predictor variables including age, gender, endoscopy indication, high sedation requirements during previous endoscopies, difficulty of the procedure, bowel preparation quality, interventions, findings as well as current use of benzodiazepines, opioids and alcohol were analyzed. The outcome of study was the use of high dose of sedation agents for the procedure. In particular, the high dose of sedation was defined as fentanyl greater than 50 mcg and midazolam greater than 3 mg. Our prediction model using the following pre-procedural variables including age, gender, indication for the procedure, medication/substance use, previous surgeries, previous high sedation requirements for colonoscopy yielded an area under the curve of 0.76 for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg. CONCLUSION: Pre-procedural planning is the key in conducting successful, efficient colonoscopy. Logistic regression analysis of 5000 patients who underwent out-patient colonoscopy revealed the following factors associated with increased sedation requirement: Younger age, female gender, difficult endoscopy, specific indications as well as cardiopulmonary complications and current use of opioids/benzodiazepines. Age and gender adjusted analysis yielded similar results. These patients are more likely to need a longer recovery periods post-endoscopy, which could result in additional time and personnel requirements. The final predictive model has good predictive ability for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg and fair predictive ability for Fentanyl ≥ 50 mcg and Midazolam ≥ 2 mg. The external validity of this model is planned to be tested in another center.
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Shingina et al. (2016) conducted an observational in Outpatient colonoscopy (n=5,000). Pre-procedural variables (younger age, female gender, difficult endoscopy, opioid/benzodiazepine use) was evaluated on Use of high dose of sedation agents (fentanyl > 50 mcg and midazolam > 3 mg) (AUC 0.76, p== 0.001). A prediction model using pre-procedural variables including age, gender, and medication use yielded an area under the curve of 0.76 for predicting high sedation requirements during colonoscopy.
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