Creation of a score to predict risk of high conscious sedation requirements in patients undergoing endoscopy

McCain, Josiah D.; Stancampiano, Fernando; Bouras, Ernest P.; DeVault, Kenneth R.; Gilbert, Emily L.; Ryan, Taylor; Maillis, Alex; Heckman, Michael G.; Diehl, Nancy N.; Palmer, William C.

doi:10.1016/j.gie.2019.11.015

Cited by 15 publications

(11 citation statements)

References 31 publications

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“…In 2014, Braunstein et al developed the Stratifying Clinical Outcomes Prior to Endoscopy (SCOPE) score, which considers a host of patient characteristics like alcohol and benzodiazepine use in determining whether they will fail endoscopist-controlled sedation [ 5 ]. Similarly, in 2020, the high conscious sedation requirements (HCSR) risk score was developed by McCain et al, which predicts sedation failure by such clinical characteristics [ 6 ]. However, neither of these scores directly considers the option of more powerful and costly anesthesia care.…”

Section: Discussionmentioning

confidence: 99%

The Role of Clinical Characteristics in Stratifying Sedation Risk: A Cohort Study

Rebello

Jamot

et al. 2021

Gastroenterol Res

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Section: Discussionmentioning

confidence: 99%

The Role of Clinical Characteristics in Stratifying Sedation Risk: A Cohort Study

Rebello

Jamot

et al. 2021

Gastroenterol Res

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“…The features included in this study were based on literature and feedback from a panel of board-certified gastroenterologists [ 4 , 10 ]. The selected features included Body mass index (BMI) recorded at the time of the procedure, demographics (age, gender, race, ethnicity, zip code), history of smoking or alcohol use, illicit substances use, visit type (inpatient, outpatient, emergency), comorbidities, current medications that can affect tolerance of moderate sedation, provider performing the procedure, and total procedure time.…”

Section: Methodsmentioning

confidence: 99%

“…Midazolam and Fentanyl are used for moderate sedation at UAMS. Based on literature and feedback from a panel of board-certified gastroenterologists [ 4 , 10 ], a sedation unit was defined as: 1) Midazolam 1 mg = 1 unit, and 2) Fentanyl 25 mcg = 1 unit. Each procedure in the dataset was labelled as low or high sedation based on the cutoff of 10 sedation units.…”

Section: Methodsmentioning

confidence: 99%

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Machine Learning Approach to Optimize Sedation Use in Endoscopic Procedures

Syed

Prior

et al. 2021

Studies in Health Technology and Informatics

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Endoscopy procedures are often performed with either moderate or deep sedation. While deep sedation is costly, procedures with moderate sedation are not always well tolerated resulting in patient discomfort, and are often aborted. Due to lack of clear guidelines, the decision to utilize moderate sedation or anesthesia for a procedure is made by the providers, leading to high variability in clinical practice. The objective of this study was to build a Machine Learning (ML) model that predicts if a colonoscopy can be successfully completed with moderate sedation based on patients’ demographics, comorbidities, and prescribed medications. XGBoost model was trained and tested on 10,025 colonoscopies (70% – 30%) performed at University of Arkansas for Medical Sciences (UAMS). XGBoost achieved average area under receiver operating characteristic curve (AUC) of 0.762, F1-score to predict procedures that need moderate sedation was 0.85, and precision and recall were 0.81 and 0.89 respectively. The proposed model can be employed as a decision support tool for physicians to bolster their confidence while choosing between moderate sedation and anesthesia for a colonoscopy procedure.

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“…While excellent guidelines from professional gastroenterology and anaesthesiology societies make some recommendations based on certain high risk factors, they do not make explicit, concrete recommendations to help triage patients to sedation type 3,8,9 . Furthermore, while some scoring systems exist they have not been widely adopted 10,11 . Additionally, the rate at which patients who are triaged to CS and do poorly or fail is unknown.…”

mentioning

confidence: 99%

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

Cassell

Ross

Chang

et al. 2020

Sci Rep

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Guidelines to triage patients to conscious sedation (cS) or monitored anaesthesia care (MAc) for colonoscopy do not exist. We aimed to identify the cS failure rate, predictors of failure, and its impact on the adenoma detection rate (ADR). Strict (based on patient experience) and expanded (based on doses of sedative medications) definitions of CS failure were used. Patient and procedure-related variables were extracted. Multivariable logistic regression identified predictors for CS failure and the ADR. Among 766 patients, 29 (3.8%) and 175 (22.8%) patients failed CS by strict and expanded definitions, respectively. Female gender (OR 3.50; 95% CI: 1.37-8.94) and fellow involvement (OR 4.15; 95% CI: 1.79-9.58) were associated with failed CS by the strict definition. Younger age (OR 1.27, 95% CI: 1.07-1.49), outpatient opiate use (OR 1.71; 95% CI 1.03-2.84), use of an adjunct medication (OR 3.34; 95% CI: 1.94-5.73), and fellow involvement (OR 2.20; 95% CI: 1.31-3.71) were associated with failed CS by the expanded definition. Patients meeting strict failure criteria had a lower ADR (OR 0.30; 95% CI: 0.12-0.77). Several clinical factors may be useful for triaging to MAC. The ADR is lower in patients meeting strict criteria for failed cS.

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Creation of a score to predict risk of high conscious sedation requirements in patients undergoing endoscopy

Cited by 15 publications

References 31 publications

The Role of Clinical Characteristics in Stratifying Sedation Risk: A Cohort Study

The Role of Clinical Characteristics in Stratifying Sedation Risk: A Cohort Study

Machine Learning Approach to Optimize Sedation Use in Endoscopic Procedures

Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate

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