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The intranasal dexmedetomidine plus ketamine for procedural sedation in children, adaptive randomized controlled non-inferiority multicenter trial (Ketodex): a statistical analysis plan
Trials
  • Anna Heath, Hospital for Sick Children University of Toronto
  • Juan David Rios, Hospital for Sick Children University of Toronto
  • Eleanor Pullenayegum, Hospital for Sick Children University of Toronto
  • Petros Pechlivanoglou, Hospital for Sick Children University of Toronto
  • Martin Offringa, Hospital for Sick Children University of Toronto
  • Maryna Yaskina, University of Alberta
  • Rick Watts, University of Alberta
  • Shana Rimmer, University of Alberta
  • Terry P. Klassen, University of Manitoba
  • Kamary Coriolano, London Health Sciences Centre
  • Naveen Poonai, Schulich School of Medicine & Dentistry
  • Darcy Beer
  • Scott Sawyer
  • Maala Bhatt
  • April Kam
  • Quynh Doan
  • Vikram Sabhaney
  • Serena Hickes
  • Samina Ali
  • Karly Stillwell
  • Tannis Erickson
  • Chelsea Bowkett
  • Chelsea Bowkett
  • Carolyn Shimmin
  • Brendon Foot
  • Candace McGahern
  • Redjana Carciurmaruj
  • Jeannine Schellenberg
Document Type
Article
Publication Date
12-1-2021
URL with Digital Object Identifier
10.1186/s13063-020-04946-3
Disciplines
Abstract

Background: Procedural sedation and analgesia (PSA) is frequently required to perform closed reductions for fractures and dislocations in children. Intravenous (IV) ketamine is the most commonly used sedative agent for closed reductions. However, as children find IV insertion a distressing and painful procedure, there is need to identify a feasible alternative route of administration. There is evidence that a combination of dexmedetomidine and ketamine (ketodex), administered intranasally (IN), could provide adequate sedation for closed reductions while avoiding the need for IV insertion. However, there is uncertainty about the optimal combination dose for the two agents and whether it can provide adequate sedation for closed reductions. The Intranasal Dexmedetomidine Plus Ketamine for Procedural Sedation (Ketodex) study is a Bayesian phase II/III, non-inferiority trial in children undergoing PSA for closed reductions that aims to address both these research questions. This article presents in detail the statistical analysis plan for the Ketodex trial and was submitted before the outcomes of the trial were available for analysis. Methods/design: The Ketodex trial is a multicenter, four-armed, randomized, double-dummy controlled, Bayesian response adaptive dose finding, non-inferiority, phase II/III trial designed to determine (i) whether IN ketodex is non-inferior to IV ketamine for adequate sedation in children undergoing a closed reduction of a fracture or dislocation in a pediatric emergency department and (ii) the combination dose for IN ketodex that provides optimal sedation. Adequate sedation will be primarily measured using the Pediatric Sedation State Scale. As secondary outcomes, the Ketodex trial will compare the length of stay in the emergency department, time to wakening, and adverse events between study arms. Discussion: The Ketodex trial will provide evidence on the optimal dose for, and effectiveness of, IN ketodex as an alternative to IV ketamine providing sedation for patients undergoing a closed reduction. The data from the Ketodex trial will be analyzed from a Bayesian perspective according to this statistical analysis plan. This will reduce the risk of producing data-driven results introducing bias in our reported outcomes. Trial registration: ClinicalTrials.gov NCT04195256. Registered on December 11, 2019.

Citation Information
Anna Heath, Juan David Rios, Eleanor Pullenayegum, Petros Pechlivanoglou, et al.. "The intranasal dexmedetomidine plus ketamine for procedural sedation in children, adaptive randomized controlled non-inferiority multicenter trial (Ketodex): a statistical analysis plan" Trials Vol. 22 Iss. 1 (2021)
Available at: http://works.bepress.com/kamary-dasilva/2/