Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study
Gal Neuman,1,* Rana Swed Tobia,2,* Liron Koren,3 Ronit Leiba,4 Itai Shavit5 1Clinical Pharmacology and Toxicology Unit, 2Department of Pediatrics, Ruth Children’s Hospital, Rambam Health Care Campus, 3Rappaport Faculty of Medicine, Technion – Institute of Technology, 4Quality of...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2018-02-01
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| Series: | Journal of Pain Research |
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| Online Access: | https://www.dovepress.com/single-dose-oral-midazolam-for-minor-emergency-department-procedures-i-peer-reviewed-article-JPR |
| _version_ | 1819103313071702016 |
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| author | Neuman G Swed Tobia R Koren L Leiba R Shavit I |
| author_facet | Neuman G Swed Tobia R Koren L Leiba R Shavit I |
| author_sort | Neuman G |
| collection | DOAJ |
| description | Gal Neuman,1,* Rana Swed Tobia,2,* Liron Koren,3 Ronit Leiba,4 Itai Shavit5 1Clinical Pharmacology and Toxicology Unit, 2Department of Pediatrics, Ruth Children’s Hospital, Rambam Health Care Campus, 3Rappaport Faculty of Medicine, Technion – Institute of Technology, 4Quality of Care Unit, 5Emergency Department, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel *These authors contributed equally to this work Background: In the pediatric emergency department, patients are commonly treated with a single dose of oral midazolam for minor procedures. We sought to evaluate the effect of this treatment on procedure completion rates.Methods: We conducted a single-center retrospective cohort study of all patients who were treated with pre-procedure oral midazolam between January 2011 and June 2016. The primary outcome was the procedure completion rate.Results: During the study period, 1,504 patients were treated with oral midazolam as per department protocol; 1,467 received midazolam and 37 declined midazolam. Oral midazolam was used in 14 different types of emergency department procedures. The procedure completion rates in the treatment and non-treatment groups were 1,402/1,467 (95.6%) and 24/37 (64.8%), respectively (difference 30.7%; 95% confidence interval [CI] 17.3%–46.8%); p<0.0001. Treatment group patients had procedure completion rates of 25/33 (75.8%), 165/188 (87.8%%), 1,154/1,187 (97.2%), and 58/59 (98.3%), in the less than 0.3 mg/kg group, 0.3 to less than 0.5 mg/kg group, 0.5 to less than 0.7 mg/kg group, and 0.7 to less than 0.9 mg/kg group, respectively. Multivariate regression did not demonstrate an association between sex, ethnicity, dosage of 0.5 mg/kg or greater, type of procedure, and failure to complete procedure. Severe adverse events were not recorded. A dose of less than 0.3 mg/kg was significantly associated with an increased risk of failure to complete a procedure (adjusted odds ratio 8.34, 95% CI 3.32–20.9; p<0.0001).Conclusion: The findings suggest that oral midazolam in a single dose of 0.5 mg/kg or greater is associated with successful completion of minor pediatric procedures. Keywords: midazolam, oral, procedures, child, emergency |
| first_indexed | 2024-12-22T01:48:28Z |
| format | Article |
| id | doaj.art-fb43167f6afe4cd999f45bc1c46ac263 |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-22T01:48:28Z |
| publishDate | 2018-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-fb43167f6afe4cd999f45bc1c46ac2632022-12-21T18:42:59ZengDove Medical PressJournal of Pain Research1178-70902018-02-01Volume 1131932436750Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort studyNeuman GSwed Tobia RKoren LLeiba RShavit IGal Neuman,1,* Rana Swed Tobia,2,* Liron Koren,3 Ronit Leiba,4 Itai Shavit5 1Clinical Pharmacology and Toxicology Unit, 2Department of Pediatrics, Ruth Children’s Hospital, Rambam Health Care Campus, 3Rappaport Faculty of Medicine, Technion – Institute of Technology, 4Quality of Care Unit, 5Emergency Department, Ruth Children’s Hospital, Rambam Health Care Campus, Haifa, Israel *These authors contributed equally to this work Background: In the pediatric emergency department, patients are commonly treated with a single dose of oral midazolam for minor procedures. We sought to evaluate the effect of this treatment on procedure completion rates.Methods: We conducted a single-center retrospective cohort study of all patients who were treated with pre-procedure oral midazolam between January 2011 and June 2016. The primary outcome was the procedure completion rate.Results: During the study period, 1,504 patients were treated with oral midazolam as per department protocol; 1,467 received midazolam and 37 declined midazolam. Oral midazolam was used in 14 different types of emergency department procedures. The procedure completion rates in the treatment and non-treatment groups were 1,402/1,467 (95.6%) and 24/37 (64.8%), respectively (difference 30.7%; 95% confidence interval [CI] 17.3%–46.8%); p<0.0001. Treatment group patients had procedure completion rates of 25/33 (75.8%), 165/188 (87.8%%), 1,154/1,187 (97.2%), and 58/59 (98.3%), in the less than 0.3 mg/kg group, 0.3 to less than 0.5 mg/kg group, 0.5 to less than 0.7 mg/kg group, and 0.7 to less than 0.9 mg/kg group, respectively. Multivariate regression did not demonstrate an association between sex, ethnicity, dosage of 0.5 mg/kg or greater, type of procedure, and failure to complete procedure. Severe adverse events were not recorded. A dose of less than 0.3 mg/kg was significantly associated with an increased risk of failure to complete a procedure (adjusted odds ratio 8.34, 95% CI 3.32–20.9; p<0.0001).Conclusion: The findings suggest that oral midazolam in a single dose of 0.5 mg/kg or greater is associated with successful completion of minor pediatric procedures. Keywords: midazolam, oral, procedures, child, emergencyhttps://www.dovepress.com/single-dose-oral-midazolam-for-minor-emergency-department-procedures-i-peer-reviewed-article-JPRMidazolamoralprocedures |
| spellingShingle | Neuman G Swed Tobia R Koren L Leiba R Shavit I Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study Journal of Pain Research Midazolam oral procedures |
| title | Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study |
| title_full | Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study |
| title_fullStr | Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study |
| title_full_unstemmed | Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study |
| title_short | Single dose oral midazolam for minor emergency department procedures in children: a retrospective cohort study |
| title_sort | single dose oral midazolam for minor emergency department procedures in children a retrospective cohort study |
| topic | Midazolam oral procedures |
| url | https://www.dovepress.com/single-dose-oral-midazolam-for-minor-emergency-department-procedures-i-peer-reviewed-article-JPR |
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