New Checklist From India For ECT AEs

Out on PubMed, from authors in India, is this article:

Development, validation and clinical utility of short-term adverse-effects of electroconvulsive therapy (SAVE) checklist.

Uppinkudru C, Pathak H, Kumar K R, S B, Bagali K, Pantoji M, Ezhumalai N, Parlikar R, Shah V, Balachander S, Sreeraj VS, Mehta UM, Sinha P, Arumugham SS, Venkatasubramanian G, Thirthalli J.Psychiatry Res. 2024 Mar 7;335:115839. doi: 10.1016/j.psychres.2024.115839. Online ahead of print.PMID: 38503006

The abstract is copied below:

Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. However, it has many cognitive and non-cognitive adverse effects (AEs). There are lacunae in the literature on systematic assessment of non-cognitive AEs. There is a need for a standard, comprehensive and specific clinical tool to evaluate this. Hence, a checklist of short-term AEs of ECT (SAVE) with a 2-phase assessment was developed. Content validation was done using 15 experts' ratings and predefined content validity ratio and index (CVR and CVI) in a two-stage modified Delphi method. The checklist had a good CVR and CVI with a final tool of 39 items. The tool was sensitive and identified the non-cognitive AEs after ECT. Cardiovascular and musculoskeletal systems displayed the highest incidence. Many participants exhibited delayed recovery in orientation, gait, and stance, highlighting a necessity for meticulous monitoring. SAVE is the first standardised tool to assess short-term ECT-related AEs systematically. This checklist likely identifies clinically significant incidences of adverse effects. Its regular use may enhance the safety of ECT and patient comfort by supporting early identification and intervention for AEs. However, given the transient nature of AEs, further studies are needed to determine their predictive validity for long-term consequences.

Keywords: Common side effects; Gait; Orientation; Psychiatric disorders; Recovery; Stance.

The article is here.

And from the text:

This is a well-intended effort to develop a checklist to record/rate adverse events after ECT, with the aim of improving practice standards. Whether this is really necessary, and if it would have the desired result, are unclear. 

Certainly, some specific items are flawed, particularly the assessment/definition of delirium, which was recorded in a very high percentage of their patients. 

The downside of such an effort could be that the data, taken out of context, or purposely misinterpreted, could be appropriated by anti-ECT activists.

As it stands, we know a tremendous amount about the safety and tolerability of ECT (both excellent). Whether the new "SAVE" checklist, which takes ~15 mins to administer, would be a help or a hindrance to practice, remains to be seen.