Brief Article
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World J Gastrointest Endosc. Oct 16, 2013; 5(10): 502-507
Published online Oct 16, 2013. doi: 10.4253/wjge.v5.i10.502
Post-Anaesthetic Discharge Scoring System to assess patient recovery and discharge after colonoscopy
Lucio Trevisani, Viviana Cifalà, Giuseppe Gilli, Vincenzo Matarese, Angelo Zelante, Sergio Sartori
Lucio Trevisani, Viviana Cifalà, Giuseppe Gilli, Vincenzo Matarese, Angelo Zelante, Sergio Sartori, Digestive Endoscopy, Department of Medicine, University Hospital “S. Anna”, 44124 Cona (FE), Italy
Lucio Trevisani, Modulo Dipartimentale di Endoscopia Digestiva, Azienda Ospedaliero-Universitaria “Arcispedale S. Anna”, 44124 Cona (FE), Italy
Author contributions: Trevisani L, Cifalà V, Zelante A and Matarese V performed the colonoscopies; Gilli G analyzed the data; Trevisani L and Sartori S designed the study and wrote the manuscript.
Correspondence to: Lucio Trevisani, MD, Digestive Endoscopy, Department of Medicine, University Hospital “S. Anna”, Via A. Moro 8, 44124 Cona (FE), Italy. tvl@unife.it
Telephone: +39-532-237558 Fax: +39-532-236932
Received: June 18, 2013
Revised: August 13, 2013
Accepted: August 20, 2013
Published online: October 16, 2013
Abstract

AIM: To investigate whether discharge scoring criteria are as safe as clinical criteria for discharge decision and allow for earlier discharge.

METHODS: About 220 consecutive outpatients undergoing colonoscopy under sedation with Meperidine plus Midazolam were enrolled and assigned to 2 groups: in Control-group (110 subjects) discharge decision was based on the clinical assessment; in PADSS-group (110 subjects) discharge decision was based on the modified Post-Anaesthetic Discharge Scoring System (PADSS). Measurements of the PADDS score were taken every 20 min after colonoscopy, and patients were discharged after two consecutive PADSS scores ≥ 9. The investigator called each patient 24-48 h after discharge to administer a standardized questionnaire, to detect any delayed complications. Patients in which cecal intubation was not performed and those who were not found at follow-up phone call were excluded from the study.

RESULTS: Thirteen patients (7 in Control-group and 6 in PADSS-group) were excluded from the study. Recovery from sedation was faster in PADSS-group than in Control-group (58.75 ± 18.67 min vs 95.14 ± 10.85 min, respectively; P < 0.001). Recovery time resulted shorter than 60 min in 39 patients of PADSS-group (37.5%), and in no patient of Control-group (P < 0.001). At follow-up phone call, no patient declared any hospital re-admission because of problems related to colonoscopy and/or sedation. Mild delayed post-discharge symptoms occurred in 57 patients in Control-group (55.3%) and in 32 in PADSS-group (30.7%). The most common symptoms were drowsiness, weakness, abdominal distension, and headache. Only 3 subjects needed to take some drugs because of post-discharge symptoms.

CONCLUSION: The Post-Anaesthetic Discharge Scoring System is as safe as the clinical assessment and allows for an earlier patient discharge after colonoscopy performed under sedation.

Keywords: Colonoscopy, Conscious sedation, Patient discharge, Recovery room, Complications

Core tip: About 220 consecutive outpatients undergoing colonoscopy under sedation were enrolled to investigate whether the Post-Anaesthetic Discharge Scoring System (PADSS) is a safe clinical assessment for earlier patient discharge after colonoscopy. The patients were assigned to two groups: in Control-group (110 subjects) discharge decision was based on the clinical assessment; in PADSS-group (110 subjects) discharge decision was based on the modified PADSS. Recovery from sedation was faster in PADSS-group than in Control-group (58.75 min vs 95.14 min, P < 0.001). Recovery time resulted shorter than 60 min in 39 patients in PADSS-group (37.5%), and in no patient in Control-group (P < 0.001).