Ketamine sedation in children: one sentinel event in 24,000, and adding GCS to the shock index sharpens paediatric trauma triage

The edition in brief

A systematic review of 20 studies covering 58,752 children given intravenous ketamine for emergency department procedural sedation found no deaths or permanent harm; sentinel events such as intubation or aspiration occurred in about 1 in 24,390 sedations, and serious adverse events in 0.33%, modestly more often in children aged 10 or over, with an upper respiratory infection, or given opioids. ASA class and co-administered benzodiazepines did not predict events. A meta-analysis of paediatric trauma found the reverse shock index multiplied by GCS was more strongly and consistently associated with mortality than the age-adjusted shock index, while both flagged transfusion need. In 1,731 emergency department patients with pulmonary embolism, the Composite Pulmonary Embolism Shock score performed similarly to sPESI and ESC classes for deterioration or death (AUC 0.68), but better for predicting advanced intervention (AUC 0.78). A claims study of 7,898 ventilated ICU survivors found 42.8% of new psychoactive prescriptions in the month after discharge had no documented supporting diagnosis. The pearl is on euglycaemic ketoacidosis with SGLT2 inhibitors.