Physicians treat agitated patients on a daily basis in the emergency department (ED). In many cases, it is challenging to distinguish the cause of the agitation, and these patients require thorough workups. A recent study, published in Annals of Emergency Medicine, provides us with better quality data to help guide our utilization of particular intramuscular medications used to treat acute agitation.[1]
In this prospective observational study, researchers compared the efficacy of four agents that can be utilized for undifferentiated agitation in the ED. The study was conducted at an inner city level 1 trauma center with an annual census of more than 100,000 visits between June 2017 and October 2017. In total, 737 patients were enrolled. Medications were dispensed according to a protocol that involved using one specific study agent during 3-week blocks. The intramuscular medications and doses tested included haloperidol 5 mg, midazolam 5 mg, olanzapine 10 mg, haloperidol 10 mg, and ziprasidone 20 mg.
The primary outcome was the proportion of patients adequately sedated at 15 minutes, using the Altered Mental Status Scale to quantify level of sedation. The only inclusion criterion was a patient requiring medication for acute agitation. Exclusion criteria were age younger than 18 years and being a prisoner or under arrest.
