Evidence map›Paper›PMID 27311910›Full record

SynthesisBMJ open2016

Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis.

M Fernanda Bellolio, Henrique A Puls, Jana L Anderson, Waqas I Gilani, M Hassan Murad, Patricia Barrionuevo, Patricia J Erwin, Zhen Wang, Erik P Hess

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 5 pooled it
9.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

51 citing papers in PubMed, 5 syntheses or guidelines pooled it, 142 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Pooled it
  4. The epidemiology and phenomenology of non-antipsychotic-induced dystonia: a hybrid systematic-narrative review.European psychiatry : the journal of the Association of European Psychiatrists · 2025
    Pooled it
  5. Guideline
  6. Trial
  7. Trial
  8. Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. Article
  14. Effective and safe pediatric sedation.Anesthesia and pain medicine · 2024
    Article
  15. Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 2 countries.

M Fernanda BellolioDepartment of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Henrique A PulsUniversidade Federal das Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Jana L AndersonDepartment of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Waqas I GilaniDepartment of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
M Hassan MuradRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Patricia BarrionuevoRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Patricia J ErwinMayo Clinic Libraries, Rochester, Minnesota, USA.
Zhen WangRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Erik P HessDepartment of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Mayo Clinic · USMayo Clinic in Arizona · USUniversidade Federal de Ciências da Saúde de Porto Alegre · BRWinnMed · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

OBJECTIVE AND

designWe conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

settingED.

participantsChildren.

interventionsProcedural sedation. OUTCOMES: Adverse events like vomiting, agitation, hypoxia and apnoea. Meta-analysis was performed with random-effects model and reported as incidence rates with 95% CIs.

resultsA total of 1177 studies were retrieved for screening and 258 were selected for full-text review. 41 studies reporting on 13 883 procedural sedations in 13 876 children (≤18 years) were included. The most common adverse events (all reported per 1000 sedations) were: vomiting 55.5 (CI 45.2 to 65.8), agitation 17.9 (CI 12.2 to 23.7), hypoxia 14.8 (CI 10.2 to 19.3) and apnoea 7.1 (CI 3.2 to 11.0). The need to intervene with either bag valve mask, oral airway or positive pressure ventilation occurred in 5.0 per 1000 sedations (CI 2.3 to 7.6). The incidences of severe respiratory events were: 34 cases of laryngospasm among 8687 sedations (2.9 per 1000 sedations, CI 1.1 to 4.7; absolute rate 3.9 per 1000 sedations), 4 intubations among 9136 sedations and 0 cases of aspiration among 3326 sedations. 33 of the 34 cases of laryngospasm occurred in patients who received ketamine.

conclusionsSerious adverse respiratory events are very rare in paediatric procedural sedation in the ED. Emesis and agitation are the most frequent adverse events. Hypoxia, a late indicator of respiratory depression, occurs in 1.5% of sedations. Laryngospasm, though rare, happens most frequently with ketamine. The results of this study provide quantitative risk estimates to facilitate shared decision-making, risk communication, informed consent and resource allocation in children undergoing procedural sedation in the ED.

Indexed as

Emergency Service, HospitalAnesthetics, DissociativeChildDrug-Related Side Effects and Adverse ReactionsHumansIncidenceKetamineObservational Studies as TopicPediatricsProcedural SedationRandomized Controlled Trials as TopicVomitingAnesthetics, DissociativeKetamineACCIDENT & EMERGENCY MEDICINE

Identifiers

PMID27311910
PMCPMC4916627
OpenAlexW2443301752

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.