Gastric point-of-care ultrasound evaluation in pediatric emergency department procedural sedation patients; is the stomach empty at the point of scheduled revisit?
1Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 10326 Goyang, Republic of Korea
2Department of Emergency Medicine, Inje University College of Medicine and Seoul Paik Hospital, 04551 Seoul, Republic of Korea
DOI: 10.22514/sv.2021.109 Vol.17,Issue 6,November 2021 pp.59-65
Submitted: 25 March 2021 Accepted: 21 May 2021
Published: 08 November 2021
Objectives: This study aimed to use gastric point of care ultrasound (POCUS) to estimate the prevalence of an “empty stomach” among patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED) after observing the requisite fasting time at home.
Methods: A prospective observational study was conducted with children with facial lacerations who made a scheduled revisit to the ED after completion of the recommended fasting time. Their stomach contents were assessed with a sagittal view of the gastric antrum by POCUS in the right lateral decubitus position. The characteristics of gastric contents were described as empty, solid, and liquid with an estimated gastric volume. “Empty stomach” was defined as a collapsed gastric antrum or calculated a gastric fluid volume of less than or equal to 1.25 mL/kg on POCUS.
Results: Gastric POCUS was performed in 125 patients, and the final analysis included 122 patients. For 95 patients who had followed the recommended fasting time, the median fasting time was 7 hours for solids and 6 hours for liquids, and 78 (82%) patients had an empty stomach. Conversely, seven of 27 patients (26%) who did not have an adequate fasting time had an empty stomach. The optimal cut-off value of fasting time to predict an empty stomach was 6.5 hours based on a receiver operating characteristic (ROC) analysis (sensitivity = 0.767, specificity = 0.811).
Conclusions: Most scheduled revisiting children had an “empty stomach” at the time of sedation after the recommended fasting. However, providers should be aware that one in five children still had stomach residue, although they had more than 6 hours of fasting.
Ultrasonography; Gastric emptying; Pediatrics
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