Creation of a Score to Predict Risk of High Conscious Sedation Requirements in Patients Undergoing Endoscopy

Abstract Background and Aims The administration of intravenous conscious sedation to patients undergoing GI endoscopy carries risk of cardiopulmonary adverse events. Our study aim was to create a score that stratifies risk of occurrence of either high-dose conscious sedation requirements or a failed procedure. Methods Patients receiving endoscopy via endoscopist-directed conscious sedation were included. The primary outcome was occurrence of a “sedation failure,” which was defined as one of the following:(1) high dose sedation, (2) the need for benzodiazepine/narcotic reversal agents, (3) nurse-documented “poor patient tolerance” to the procedure, or (4) aborted procedure. High-dose sedation was defined as >10 mg of midazolam, and/or >200 μg of fentanyl or the meperidine equivalent. Patients with sedation failure (N=488) were matched to controls (N=976) without a sedation failure by endoscopist and endoscopy date. Results Significant associations with sedation failure were identified for age, sex, nonclonazepam benzodiazepine use, opioid use, and procedure type (EGD, colonoscopy, or both). Based on these 5 variables, we created the high conscious sedation requirements (HCSR) score, which predicted risk of sedation failure with an AUC of 0.70. Compared with the patients with a risk score of 0, risk of a sedation failure was highest for patients with a score ≥3.5 (OR, 17.31; P=2 x 10-14). Estimated AUC of the HCSR score was 0.68 (95% CI, 0.63-0.72) in a validation series of 250 cases and 250 controls. Conclusions The HCSR risk score, based on 5 key patient and procedure characteristics, can function as a useful tool for physicians when discussing sedation options with patients before endoscopy.