314 Association Between the Shorter Length of Stay in Emergency Department and the Use of Propofol Among Patients Required Procedural Sedation and Analgesia

Abstract

Procedural sedation and analgesia (PSA) is essential for emergency physicians when patients need painful or uncomfortable procedures. Propofol, midazolam and ketamine are commonly used in the emergency department (ED) for PSA. Painful or uncomfortable procedures become difficult when PSA is inadequate because patients tend to be agitated due to pain or distress. In such cases, additional sedative agents are often administrated. If additional sedative agents are administrated repeatedly, it could cause over-sedation. Over-sedation results in extended ED stay and or any other adverse events such as desaturation. Previous studies showed that propofol could shorten the length of sedation compared to other sedative agents including midazolam and ketamine. However, whether it affects the length of stay (LOS) in ED is unclear. Our hypothesis was that the propofol use for PSA is associated with shorter LOS in ED than other agents. We conducted a single-center, retrospective cohort study. We included patients who were proceeded PSA in the ED from May 2017 to November 2019. Excluded criteria were data missing, required admission, and use of 2 or more sedative agents. Eligible patients were divided into two groups, the propofol group, and other agents (midazolam and ketamine) group. Covariables were age, physical status before PSA, targeted depth of sedative level, the indication of sedation (reduction of dislocation or fracture, suture, defibrillating shock, Imaging test), and practitioner (attending or resident). A total of 124 patients were eligible for cases. Their median age was 30.5 years old. Forty-six cases were included in the propofol group and 76 were included in other agents’ group. Their median LOS in ED was 84 minutes (Interquartile Range (IQR) 70-105) and 103 minutes (IQR 77-151). After adjusting for five potential confounders, PSA by propofol was significantly associated with the shorter LOS in ED (hazard ratio 2.21, 95% confidential interval 1.34-3.65, p-value <0.01). The use of propofol for PSA was associated with shorter LOS in ED. This result could resolve ED crowding.