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Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?

Published online by Cambridge University Press:  04 March 2015

Frank Xavier Scheuermeyer ,
Gary Andolfatto ,
Lisa Lange ,
Danielle de Jong ,
Hong Qian  and
Eric Grafstein
Frank Xavier Scheuermeyer*
Affiliation:
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC
Gary Andolfatto
Affiliation:
Department of Emergency Medicine, Lions Gate Hospital and the University of British Columbia, North Vancouver, BC
Lisa Lange
Affiliation:
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC
Danielle de Jong
Affiliation:
Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC
Hong Qian
Affiliation:
Center for Health Evaluation and Outcome Sources (CHEOS), St Paul's Hospital and the University of British Columbia, Vancouver, BC
Eric Grafstein
Affiliation:
Department of Emergency Medicine, Mount St Joseph's Hospital and the University of British Columbia, Vancouver, BC
*
Department of Emergency Medicine, St Paul's Hospital, 1081 Burrard Street, Vancouver BC; frank.scheuermeyer@gmail.com

Abstract

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Objective:

Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) in the emergency department (ED). We compared adverse events (AEs) for IDUs to those for non-IDUs receiving PSA for incision and drainage of cutaneous abscesses.

Methods:

This was a retrospective analysis of a PSA safety audit. IDU status was prospectively documented among consecutive patients undergoing PSA at two urban EDs. Structured data describing comorbidities, vital signs, sedation regimens, and adverse events were collected. Primary outcome was the proportion of patients in each group experiencing an AE, whereas the secondary outcomes included recovery times.

Results:

Of 525 consecutive patients receiving PSA for incision and drainage of an abscess, 244 were deemed IDUs and 281 non-IDUs. IDUs received higher doses of sedatives and analgesics, and 14 experienced AEs (5.7%), whereas 10 non-IDUs had AEs (3.6%), for a risk difference of 2.1% (95% CI -1.8, 6.5). Median recovery times were 18 minutes (interquartile range [IQR] 10-36) for IDUs and 12 minutes (IQR 7-19) for non-IDUs, for a difference of 6 minutes (95% CI 2-9 minutes). Median sedation times were also longer in IDUs, for a difference of 6 minutes (95% CI 5-10 minutes). Of 20 IDU patients and 1 non-IDU patient admitted to hospital, none had experienced an AE related to PSA.

Conclusions:

For ED patients requiring PSA for incision and drainage, IDUs had an AE rate similar to that of non-IDUs but longer sedation and recovery times. In experienced hands, PSA may be as safe in IDUs as in patients who do not use injection drugs.

Keywords

infectious diseasesmarginalized populationspain management
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 2 , March 2012 , pp. 90 - 100
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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