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Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department
Agitation in the emergency department (ED) can pose a threat to patient and provider safety; therefore, treatment is indicated. The purpose of this study is to compare haloperidol, olanzapine, midazolam, and ziprasidone to treat agitation. This was a prospective observational study of consecutive pa...
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| Published in: | Annals of emergency medicine 2018-10, Vol.72 (4), p.374-385 |
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| cites | cdi_FETCH-LOGICAL-c377t-d963776b0ef7cb4ed7f6f0aef3590b6fe0d98fcc256826e3d9a2767c43e487c13 |
| container_end_page | 385 |
| container_issue | 4 |
| container_start_page | 374 |
| container_title | Annals of emergency medicine |
| container_volume | 72 |
| creator | Klein, Lauren R. Driver, Brian E. Miner, James R. Martel, Marc L. Hessel, Michelle Collins, Jacob D. Horton, Gabriella B. Fagerstrom, Erik Satpathy, Rajesh Cole, Jon B. |
| description | Agitation in the emergency department (ED) can pose a threat to patient and provider safety; therefore, treatment is indicated. The purpose of this study is to compare haloperidol, olanzapine, midazolam, and ziprasidone to treat agitation.
This was a prospective observational study of consecutive patients receiving intramuscular medication to treat agitation in the ED. Medications were administered according to an a priori protocol in which the initial medication given was predetermined in the following 3-week blocks: haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, midazolam 5 mg, and haloperidol 10 mg. The primary outcome was the proportion of patients adequately sedated at 15 minutes, assessed with the Altered Mental Status Scale.
Seven hundred thirty-seven patients were enrolled (median age 40 years; 72% men). At 15 minutes, midazolam resulted in a greater proportion of patients adequately sedated (Altered Mental Status Scale |
| doi_str_mv | 10.1016/j.annemergmed.2018.04.027 |
| format | article |
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This was a prospective observational study of consecutive patients receiving intramuscular medication to treat agitation in the ED. Medications were administered according to an a priori protocol in which the initial medication given was predetermined in the following 3-week blocks: haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, midazolam 5 mg, and haloperidol 10 mg. The primary outcome was the proportion of patients adequately sedated at 15 minutes, assessed with the Altered Mental Status Scale.
Seven hundred thirty-seven patients were enrolled (median age 40 years; 72% men). At 15 minutes, midazolam resulted in a greater proportion of patients adequately sedated (Altered Mental Status Scale <1) compared with ziprasidone (difference 18%; 95% confidence interval [CI] 6% to 29%), haloperidol 5 mg (difference 30%; 95% CI 19% to 41%), haloperidol 10 mg (difference 28%; 95% CI 17% to 39%), and olanzapine (difference 9%; 95% CI –1% to 20%). Olanzapine resulted in a greater proportion of patients adequately sedated at 15 minutes compared with haloperidol 5 mg (difference 20%; 95% CI 10% to 31%), haloperidol 10 mg (difference 18%; 95% CI 7% to 29%), and ziprasidone (difference 8%; 95% CI –3% to 19%). Adverse events were uncommon: cardiac arrest (0), extrapyramidal adverse effects (2; 0.3%), hypotension (5; 0.5%), hypoxemia (10; 1%), and intubation (4; 0.5%), and occurred at similar rates in each group.
Intramuscular midazolam achieved more effective sedation in agitated ED patients at 15 minutes than haloperidol, ziprasidone, and perhaps olanzapine. Olanzapine provided more effective sedation than haloperidol. No differences in adverse events were identified.</description><identifier>ISSN: 0196-0644</identifier><identifier>EISSN: 1097-6760</identifier><identifier>DOI: 10.1016/j.annemergmed.2018.04.027</identifier><identifier>PMID: 29885904</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject><![CDATA[Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antipsychotic Agents - administration & dosage ; Antipsychotic Agents - therapeutic use ; Cohort Studies ; Emergency Medical Services ; Female ; Haloperidol - administration & dosage ; Haloperidol - therapeutic use ; Humans ; Injections, Intramuscular ; Male ; Mental Status and Dementia Tests ; Midazolam - administration & dosage ; Midazolam - therapeutic use ; Middle Aged ; Olanzapine - administration & dosage ; Olanzapine - therapeutic use ; Piperazines - administration & dosage ; Piperazines - therapeutic use ; Prospective Studies ; Psychomotor Agitation - drug therapy ; Thiazoles - administration & dosage ; Thiazoles - therapeutic use ; Treatment Outcome ; Young Adult]]></subject><ispartof>Annals of emergency medicine, 2018-10, Vol.72 (4), p.374-385</ispartof><rights>2018 American College of Emergency Physicians</rights><rights>Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-d963776b0ef7cb4ed7f6f0aef3590b6fe0d98fcc256826e3d9a2767c43e487c13</citedby><cites>FETCH-LOGICAL-c377t-d963776b0ef7cb4ed7f6f0aef3590b6fe0d98fcc256826e3d9a2767c43e487c13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29885904$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Klein, Lauren R.</creatorcontrib><creatorcontrib>Driver, Brian E.</creatorcontrib><creatorcontrib>Miner, James R.</creatorcontrib><creatorcontrib>Martel, Marc L.</creatorcontrib><creatorcontrib>Hessel, Michelle</creatorcontrib><creatorcontrib>Collins, Jacob D.</creatorcontrib><creatorcontrib>Horton, Gabriella B.</creatorcontrib><creatorcontrib>Fagerstrom, Erik</creatorcontrib><creatorcontrib>Satpathy, Rajesh</creatorcontrib><creatorcontrib>Cole, Jon B.</creatorcontrib><title>Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department</title><title>Annals of emergency medicine</title><addtitle>Ann Emerg Med</addtitle><description>Agitation in the emergency department (ED) can pose a threat to patient and provider safety; therefore, treatment is indicated. The purpose of this study is to compare haloperidol, olanzapine, midazolam, and ziprasidone to treat agitation.
This was a prospective observational study of consecutive patients receiving intramuscular medication to treat agitation in the ED. Medications were administered according to an a priori protocol in which the initial medication given was predetermined in the following 3-week blocks: haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, midazolam 5 mg, and haloperidol 10 mg. The primary outcome was the proportion of patients adequately sedated at 15 minutes, assessed with the Altered Mental Status Scale.
Seven hundred thirty-seven patients were enrolled (median age 40 years; 72% men). At 15 minutes, midazolam resulted in a greater proportion of patients adequately sedated (Altered Mental Status Scale <1) compared with ziprasidone (difference 18%; 95% confidence interval [CI] 6% to 29%), haloperidol 5 mg (difference 30%; 95% CI 19% to 41%), haloperidol 10 mg (difference 28%; 95% CI 17% to 39%), and olanzapine (difference 9%; 95% CI –1% to 20%). Olanzapine resulted in a greater proportion of patients adequately sedated at 15 minutes compared with haloperidol 5 mg (difference 20%; 95% CI 10% to 31%), haloperidol 10 mg (difference 18%; 95% CI 7% to 29%), and ziprasidone (difference 8%; 95% CI –3% to 19%). Adverse events were uncommon: cardiac arrest (0), extrapyramidal adverse effects (2; 0.3%), hypotension (5; 0.5%), hypoxemia (10; 1%), and intubation (4; 0.5%), and occurred at similar rates in each group.
Intramuscular midazolam achieved more effective sedation in agitated ED patients at 15 minutes than haloperidol, ziprasidone, and perhaps olanzapine. Olanzapine provided more effective sedation than haloperidol. No differences in adverse events were identified.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antipsychotic Agents - administration & dosage</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Cohort Studies</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Haloperidol - administration & dosage</subject><subject>Haloperidol - therapeutic use</subject><subject>Humans</subject><subject>Injections, Intramuscular</subject><subject>Male</subject><subject>Mental Status and Dementia Tests</subject><subject>Midazolam - administration & dosage</subject><subject>Midazolam - therapeutic use</subject><subject>Middle Aged</subject><subject>Olanzapine - administration & dosage</subject><subject>Olanzapine - therapeutic use</subject><subject>Piperazines - administration & dosage</subject><subject>Piperazines - therapeutic use</subject><subject>Prospective Studies</subject><subject>Psychomotor Agitation - drug therapy</subject><subject>Thiazoles - administration & dosage</subject><subject>Thiazoles - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0196-0644</issn><issn>1097-6760</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqNkEFv1DAQhS1ERZfCX0DmxqFJx0nWTo6rpdBKRb20l14srz1evEqcYDuVtr8eR9tKHDmN3vjNjN9HyFcGJQPGrw6l8h4HDPsBTVkBa0toSqjEO7Ji0ImCCw7vyQpYxwvgTXNOPsZ4AICuqdgHcl51bbvuoFmR461PQQ1z1HOvAv3ljHoZezVc0vte-Rc1OY-X9MlNQUVnxkWMgd6ofpww5EZPbdYPAVVyfk83ek5IN3uXsh49dZ6m30ivl7-i10f6HScV0oA-fSJnVvURP7_WC_L44_phe1Pc3f-83W7uCl0LkQrT8Vz5DtAKvWvQCMstKLR1DrDjFsF0rdW6WvO24libTlWCC93U2LRCs_qCfDvtncL4Z8aY5OCixj7Hw3GOsoJ1XQmo2WLtTlYdxhgDWjkFN6hwlAzkQl4e5D_k5UJeQiMz-Tz75fXMvFve3ibfUGfD9mTAHPbZYZBRu8wEjQuokzSj-48zfwF--J0S</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Klein, Lauren R.</creator><creator>Driver, Brian E.</creator><creator>Miner, James R.</creator><creator>Martel, Marc L.</creator><creator>Hessel, Michelle</creator><creator>Collins, Jacob D.</creator><creator>Horton, Gabriella B.</creator><creator>Fagerstrom, Erik</creator><creator>Satpathy, Rajesh</creator><creator>Cole, Jon B.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201810</creationdate><title>Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department</title><author>Klein, Lauren R. ; Driver, Brian E. ; Miner, James R. ; Martel, Marc L. ; Hessel, Michelle ; Collins, Jacob D. ; Horton, Gabriella B. ; Fagerstrom, Erik ; Satpathy, Rajesh ; Cole, Jon B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-d963776b0ef7cb4ed7f6f0aef3590b6fe0d98fcc256826e3d9a2767c43e487c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antipsychotic Agents - administration & dosage</topic><topic>Antipsychotic Agents - therapeutic use</topic><topic>Cohort Studies</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Haloperidol - administration & dosage</topic><topic>Haloperidol - therapeutic use</topic><topic>Humans</topic><topic>Injections, Intramuscular</topic><topic>Male</topic><topic>Mental Status and Dementia Tests</topic><topic>Midazolam - administration & dosage</topic><topic>Midazolam - therapeutic use</topic><topic>Middle Aged</topic><topic>Olanzapine - administration & dosage</topic><topic>Olanzapine - therapeutic use</topic><topic>Piperazines - administration & dosage</topic><topic>Piperazines - therapeutic use</topic><topic>Prospective Studies</topic><topic>Psychomotor Agitation - drug therapy</topic><topic>Thiazoles - administration & dosage</topic><topic>Thiazoles - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Klein, Lauren R.</creatorcontrib><creatorcontrib>Driver, Brian E.</creatorcontrib><creatorcontrib>Miner, James R.</creatorcontrib><creatorcontrib>Martel, Marc L.</creatorcontrib><creatorcontrib>Hessel, Michelle</creatorcontrib><creatorcontrib>Collins, Jacob D.</creatorcontrib><creatorcontrib>Horton, Gabriella B.</creatorcontrib><creatorcontrib>Fagerstrom, Erik</creatorcontrib><creatorcontrib>Satpathy, Rajesh</creatorcontrib><creatorcontrib>Cole, Jon B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Klein, Lauren R.</au><au>Driver, Brian E.</au><au>Miner, James R.</au><au>Martel, Marc L.</au><au>Hessel, Michelle</au><au>Collins, Jacob D.</au><au>Horton, Gabriella B.</au><au>Fagerstrom, Erik</au><au>Satpathy, Rajesh</au><au>Cole, Jon B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department</atitle><jtitle>Annals of emergency medicine</jtitle><addtitle>Ann Emerg Med</addtitle><date>2018-10</date><risdate>2018</risdate><volume>72</volume><issue>4</issue><spage>374</spage><epage>385</epage><pages>374-385</pages><issn>0196-0644</issn><eissn>1097-6760</eissn><abstract>Agitation in the emergency department (ED) can pose a threat to patient and provider safety; therefore, treatment is indicated. The purpose of this study is to compare haloperidol, olanzapine, midazolam, and ziprasidone to treat agitation.
This was a prospective observational study of consecutive patients receiving intramuscular medication to treat agitation in the ED. Medications were administered according to an a priori protocol in which the initial medication given was predetermined in the following 3-week blocks: haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, midazolam 5 mg, and haloperidol 10 mg. The primary outcome was the proportion of patients adequately sedated at 15 minutes, assessed with the Altered Mental Status Scale.
Seven hundred thirty-seven patients were enrolled (median age 40 years; 72% men). At 15 minutes, midazolam resulted in a greater proportion of patients adequately sedated (Altered Mental Status Scale <1) compared with ziprasidone (difference 18%; 95% confidence interval [CI] 6% to 29%), haloperidol 5 mg (difference 30%; 95% CI 19% to 41%), haloperidol 10 mg (difference 28%; 95% CI 17% to 39%), and olanzapine (difference 9%; 95% CI –1% to 20%). Olanzapine resulted in a greater proportion of patients adequately sedated at 15 minutes compared with haloperidol 5 mg (difference 20%; 95% CI 10% to 31%), haloperidol 10 mg (difference 18%; 95% CI 7% to 29%), and ziprasidone (difference 8%; 95% CI –3% to 19%). Adverse events were uncommon: cardiac arrest (0), extrapyramidal adverse effects (2; 0.3%), hypotension (5; 0.5%), hypoxemia (10; 1%), and intubation (4; 0.5%), and occurred at similar rates in each group.
Intramuscular midazolam achieved more effective sedation in agitated ED patients at 15 minutes than haloperidol, ziprasidone, and perhaps olanzapine. Olanzapine provided more effective sedation than haloperidol. No differences in adverse events were identified.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29885904</pmid><doi>10.1016/j.annemergmed.2018.04.027</doi><tpages>12</tpages></addata></record> |
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| ispartof | Annals of emergency medicine, 2018-10, Vol.72 (4), p.374-385 |
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| language | eng |
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| source | ScienceDirect Freedom Collection 2022-2024 |
| subjects | Adolescent Adult Aged Aged, 80 and over Antipsychotic Agents - administration & dosage Antipsychotic Agents - therapeutic use Cohort Studies Emergency Medical Services Female Haloperidol - administration & dosage Haloperidol - therapeutic use Humans Injections, Intramuscular Male Mental Status and Dementia Tests Midazolam - administration & dosage Midazolam - therapeutic use Middle Aged Olanzapine - administration & dosage Olanzapine - therapeutic use Piperazines - administration & dosage Piperazines - therapeutic use Prospective Studies Psychomotor Agitation - drug therapy Thiazoles - administration & dosage Thiazoles - therapeutic use Treatment Outcome Young Adult |
| title | Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department |
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