Agreement Between Sonographically Estimated Gastric Contents and Reported Last Meal on Fasting Status in Procedural...

Procedural sedation and analgesia (PSA) is an essential component of emergency medicine practice. Preprocedural fasting is recommended to reduce aspiration risk, but compliance with fasting in emergency settings is not necessarily feasible. Gastric ultrasound provides an objective method to assess fasting status.

To evaluate the agreement between sonographically estimated gastric contents and reported last meal on fasting status of adults undergoing PSA in the emergency department (ED).

This study was conducted in an academic ED between July 2022 and July 2024. A convenience sample of adults aged 18 to 65 years requiring PSA in the ED was enrolled. Gastric point-of-care ultrasound (POCUS) was performed to assess gastric content and volume. Sonographic classification was compared to reported fasting status using percent agreement and linear weighted Cohen's kappa with 95% CI.

A total of 182 patients (77.5% male, mean age 42.98 years ±15.48) were enrolled, with 56.5% endorsed fasting in the preceding 3 h. Gastric POCUS identified stomach contents as Grade 0 in 42.3% of patients, Grade 1 in 9.8%, and Grade 2 in 47.8%. When comparing to reported fasting history with POCUS findings, overall agreement between reported oral intake in 3 h and gastric POCUS risk grade was 73.1% (95% CI: 66.2-79.0%). Linear weighted Cohen's kappa was 0.58 (95% CI: 0.49-0.68), indicating moderate agreement. Disagreement occurred in 49 patients (26.9%), with 47 patients showing higher-risk contents by POCUS than predicted by history.

In general, gastric POCUS demonstrated moderate agreement with reported fasting status; however, there was a subset of patients in which POCUS findings deviated from the expected contents based on reported fasting times. Gastric POCUS could potentially improve risk stratification of patients undergoing PSA in the ED.