Shortened preprocedural fasting in the pediatric emergency department

Area of Science:

• Emergency Medicine
• Pediatric Sedation
• Patient Safety

Background:

• Existing guidelines for procedural sedation and analgesia (PSA) often recommend fasting periods, but evidence supporting these specific durations is limited.
• Pediatric and adult emergency medicine guidelines increasingly support avoiding delays in procedures due to fasting time.
• General pediatric guidelines outside emergent care settings remain vague regarding set fasting periods for urgent procedures.

Purpose of the Study:

• To evaluate the rates of vomiting during the implementation of a shortened preprocedural fasting protocol.
• To determine if shortened fasting times are associated with an increased incidence of emesis during procedural sedation and analgesia.

Main Methods:

• A prospective study was conducted in a children's hospital emergency center.
• Data on preprocedural fasting times and adverse events were collected for patients undergoing procedural sedation and analgesia (PSA).
• Patients were categorized into standard fasting (≥6 hours) and shortened fasting (<6 hours) groups.

Main Results:

• The study included 2188 patients with available fasting data, with 716 in the shortened fasting group.
• No statistically significant association was found between shortened fasting time and emesis, either unadjusted or adjusted for risk factors.
• The odds ratio for emesis with shortened fasting was 1.18 (95% CI 0.75-1.84) unadjusted and 1.14 (95% CI 0.74-1.75) adjusted.

Conclusions:

• Implementation of a shortened fasting protocol for PSA did not lead to an increased incidence of vomiting.
• This study provides evidence that shortened fasting times are safe and do not increase adverse events like emesis.
• Findings support revising guidelines to reduce unnecessary fasting periods before urgent and emergent procedures.