This article is more than 5 years old. Information may no longer be current.
SCOPE score predicted sedation outcomes in endoscopy patients
Researchers developed a clinical prediction score that stratified patients based on risk for difficult sedation or high sedation requirement during endoscopic procedures, according to study data.
The Stratifying Clinical Outcomes Prior to Endoscopy (SCOPE) score was developed using significant variables from a retrospective cross-sectional study of patients (mean age, 59 years; 43.6% men) who underwent esophagogastroduodenoscopy (EGD; n=13,711) or colonoscopy (n=21,763) using conscious sedation. Data was obtained from an endoscopy record system at Columbia University Medical Center from October 2006 through March 2013.
Patients with difficult sedation — 12.4% of EGD and 10.6% of colonoscopy patients — were defined as those requiring high doses of benzodiazepines and opioids (top quintile), or experiencing agitation, discomfort or other difficulty. These groups were then analyzed to measure the association of difficult sedation with multiple factors. Patients aged older than 70 years were included in analysis, but excluded from construction of the scoring system due to very low risk for difficult sedation.
Factors associated with sedation difficulty during EGD were benzodiazepine (17.7%; P=.0009) and opioid use (18.2%; P=.012), presence of a trainee (10.7%; P<.0001), procedure indication (acute GI bleed, 6.9%; abdominal pain, 13%; reflux, esophagitis, Barrett’s esophagus, 15.2%; P<.0001), psychiatric history (17.5%; P=.0002), and younger age (70.9% of difficult sedation sample aged younger than 50 years; P=.0001).
Factors linked with difficulty during colonoscopy were benzodiazepine, opioid and other psychoactive medication use (20.1%, 17.8%, 13.7%, respectively; P<.0001), BMI less than 25 (26.4%; P<.0001), female sex (12.3%; P<.0001), procedure indication (acute GI bleed, 7.4%; diagnostic/other, 14%; surveillance, 8.8%; screening, 9.4%; P<.0001), tobacco (12.4%; P=.007), and younger age (72.1% of difficult sedation sample aged younger than 50 years; P=.0001).
Five risk classes were developed for the SCOPE scoring system, based on points associated with risk factors. Risk for difficult sedation for each procedure were estimated by calculating the patient’s score, and determining the patient’s risk-stratified class (I-V).
“Because of the increase in the use of anesthesia services in routine procedures in recent years, we consider that the SCOPE score may help define those with greater sedation needs and who may benefit from the use of anesthesia services,” the researchers concluded.
Disclosure: See the study for a full list of relevant financial disclosures.