title: Adverse events and outcomes of procedural sedation and analgesia in major trauma patients.
abstract: BACKGROUND
  Trauma patients requiring procedural sedation and analgesia (PSA) may have increased risk of adverse events (AEs) and poor outcomes.
  
  
  OBJECTIVE
  To determine the incidence of AEs in adult major trauma patients who received PSA and to evaluate their postprocedural outcomes.
  
  
  METHODS
  Retrospective analysis of adult patients (age >16) who received PSA between 2006 and 2014 at a Canadian academic tertiary care center.
  
  
  METHODS
  We compared the incidence of PSA-related AEs in trauma patients with nontrauma patients. Postprocedural outcomes including Intensive Care Unit admission, length of hospital stay, and mortality were compared between trauma patients who did or did not receive PSA.
  
  
  METHODS
  Descriptive statistics and multivariable logistic regression.
  
  
  RESULTS
  Overall, 4324 patients received PSA during their procedure, of which 101 were trauma patients (107 procedures). The majority (77%) of these 101 trauma patients were male, relatively healthy (78% with American Society of Anesthesiologists Physical Status [ASA-PS] 1), and most (85%) of the 107 procedures were orthopedic manipulations. PSA-related AEs were experienced by 45.5% of the trauma group and 45.9% of the nontrauma group. In the trauma group, the most common AEs were tachypnea (23%) and hypotension (20%). After controlling for age, gender, and ASA-PS, trauma patients were more likely than nontrauma patients to develop hypotension (odds ratio 1.79; 95% confidence interval 1.11-2.89).
  
  
  CONCLUSIONS
  Although trauma patients were more likely than nontrauma patients to develop hypotension during PSA, their outcomes were not worse compared to trauma patients who did not have PSA.
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada ; Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada ; Department of Mathematics and Statistics, Dalhousie University, Halifax, NS, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Green
authors.affiliation: Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada ; Department of Mathematics and Statistics, Dalhousie University, Halifax, NS, Canada.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Butler
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Campbell
authors.affiliation: Department of Trauma Nova Scotia, Halifax, NS, Canada.
authors.forename: Mete
authors.initials: M
authors.lastname: Erdogan
keywords: Analgesia; outcomes; procedural; retrospective; sedation; trauma