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Knowledge of Procedural Sedation and Analgesia of Emergency Medicine Physicians

Maher, Emily N. MD*; Hansen, Samantha F. MD; Heine, Margaret BS; Meers, Holley MD§; Yaster, Myron MD; Hunt, Elizabeth A. MD, MPH

doi: 10.1097/pec.0b013e31815c9dbe
Original Articles

Objectives: Pediatric procedural sedation and analgesia (PSA) is unique. The goals of this study were to examine emergency medicine (EM) physicians' baseline knowledge of general and pediatric PSA compared with that of other nonanesthesiologist physicians and to test effectiveness of a seminar required for credentialing in PSA.

Methods: This was a retrospective, before and after interventional study of participants in a major university teaching hospital's PSA course. Analysis was conducted to determine: (1) performance of EM physicians on questions related to general and pediatric PSA compared with other participating physicians, and (2) effect of seminar on participants' knowledge of PSA.

Results: The mean ± SE PSA pretest score for EM physicians was higher than that of other physicians (63.7% ± 1.1% vs 50.2% ± 2.2%, P < 0.001), but not for the pediatric PSA pretest scores (54.8% ± 1.7% vs 51.0% ± 1.8%, P = 0.17). The EM practitioners performed worse on the pediatric versus the adult portion of the PSA pretest (55.2% ± 1.8% vs 66.8% ± 1.4%, P < 0.001). Practitioners trained in American Heart Association advanced life support classes performed better than the untrained (52.1 ± 1.4 vs 41.6± 2.5, P < 0.001). Total and pediatric PSA test scores improved significantly after educational intervention in all practitioners.

Conclusions: The EM physicians have stronger knowledge about general PSA than other nonanesthesiologist physician participants, but not for pediatric PSA, thus providing a target for future interventions. This course on PSA improved practitioners' knowledge of general and pediatric PSA and can be used as an educational model for PSA training. Further study is needed to determine decay rates for this knowledge and impact on patient care.

*Brigham and Women's Hospital, Boston, MA; †Oregon Health & Science University School of Medicine, Portland, OR; ‡Johns Hopkins University School of Medicine, Baltimore, MD; and §Holy Cross Hospital, Silver Spring, MD.

Address correspondence and reprint requests to Elizabeth A. Hunt, MD, MPH, Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 904, Baltimore, MD 21287. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.