Introduction: Pediatric Sedation Anesthesia- Outside Operating Room (PSA-OOR) is well described with overall low adverse events (AE) in certain settings. AE associated with PSA-OOR for Gastro-Intestinal procedures have been described in small single center studies with wide variance in outcomes. Predictors of such outcomes are unclear. Estimating the incidence of AE in children undergoing PSA-OOR for Esophagogastroduodenoscopy (EGD), Colonoscopy (Col), or both may help identify the predictors of AE. Methods: Retrospective analysis of prospectively collected EGD and Col data from Pediatric Sedation Research Consortium (PSRC) database, a web-based collaborative from 40 North American institutions (09/07-11/11). Primary outcome variable is any AE. Independent variables include-Age (5 Groups), gender, ASA status (S), procedure (only EGD, only Col, or both), medication used, location performed and presence of co-existing medical conditions (CMC). Descriptive statistics used to summarize the data. Using multivariable logistic regression model, odds ratio (OR), and 95% Confidence Intervals (CI) were computed for each independent variable. Results: 12030 procedures were performed (EGD 7970, Col 1378, both 2682), Variables include: age (Gp I: < 1y: 222; Gp II:1-5y: 2081; Gp III: > 5-10y: 3464; Gp IV: >10-15y: 428; Gp V: > 15y: 1978), male (51%), ASA (S1: 25.7%, S2: 67%, S3 or greater: 6.6%), with CMC (32%), in Sedation Unit (83%), and Propofol (97%). Overall incidence of any AE was 4.8% (582); the most common AE were persistent desats (1.5%), airway obstruction (1%), cough (0.9%) & laryngospasm (0.6%). No deaths or cardiopulmonary resuscitation (CPR). Age Group as AE % (Gp I: 35/222 (15.7%); Gp II: 162/2081 (7.8%); Gp III: 140/3464 (4%); Gp IV: 173/4285 (4%); Gp V: 72/1978 (3.6%)). Regression analysis revealed: age (Gp 1: 4.1 odds ratio (OR), 2.6-6.5, 95% confidence interval (CI), p < 0.0001; Gp 2: 2.1, 1.6-2.9, p < 0.0001, Reference (Ref) Gp 5), ASA (S2: 1.3, 1.06-1.6, p < 0.01; S3 and greater: 3.02, 2.2-4.1, p < 0.0001, Ref S1), Procedure (EGD only: 1.9, 1.3-2.6, p <0.0002, both EGD & Col: 2.2,1.5-3.2, p <0.0001, Ref Col only), presence of CMC (Metabolic/Genetic: 2.3, 1.6 – 3.3, p <0.0001, Resp-Lower Airway: 1.3, 1.01-1.72, p= 0.04, Ref No CMC) were predictors of higher AE. Conclusions: In the selected data set from the PSRC, the overall AE rate was 4.8%. Our analysis indicates that younger age, higher ASA status, EGD procedure, and presence of certain CMC were independent predictors of higher AE. The majority of such AE were minor and reversible with none of them leading to death or disability when performed in institutions with well-organized sedation systems that were able to quickly recognize and rescue at risk patients.