Asunto(s)
Dolor Abdominal/terapia , Aorta Abdominal/diagnóstico por imagen , Rotura de la Aorta/diagnóstico , Taponamiento Cardíaco/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico , Terapia Trombolítica/efectos adversos , Dolor Abdominal/etiología , Rotura de la Aorta/mortalidad , Taponamiento Cardíaco/etiología , Reanimación Cardiopulmonar , Errores Diagnósticos , Diarrea/etiología , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Derrame Pericárdico/etiología , Accidente Cerebrovascular/terapia , Vómitos/etiologíaAsunto(s)
Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Interna/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Anciano de 80 o más Años , Angiografía Cerebral , Diagnóstico Diferencial , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The safety and effectiveness of intramuscular olanzapine or haloperidol compared to midazolam as the initial pharmacological treatment for acute agitation in emergency departments (EDs) has not been evaluated. METHODS: A pragmatic, randomised, double-blind, active-controlled trial was conducted from December 2014 to September 2019, in six Hong Kong EDs. Patients (aged 18-75 years) with undifferentiated acute agitation requiring parenteral sedation were randomised to 5 mg intramuscular midazolam (n = 56), olanzapine (n = 54), or haloperidol (n = 57). Primary outcomes were time to adequate sedation and proportion of patients who achieved adequate sedation at each follow-up interval. Sedation levels were measured on a 6-level validated scale (ClinicalTrials.gov Identifier: NCT02380118). FINDINGS: Of 206 patients randomised, 167 (mean age, 42 years; 98 [58·7%] male) were analysed. Median time to sedation for IM midazolam, olanzapine, and haloperidol was 8·5 (IQR 8·0), 11·5 (IQR 30·0), and 23·0 (IQR 21·0) min, respectively. At 60 min, similar proportions of patients were adequately sedated (98%, 87%, and 97%). There were statistically significant differences for time to sedation with midazolam compared to olanzapine (p = 0·03) and haloperidol (p = 0·002). Adverse event rates were similar across the three arms. Dystonia (n = 1) and cardiac arrest (n = 1) were reported in the haloperidol group. INTERPRETATION: Midazolam resulted in faster sedation in patients with undifferentiated agitation in the emergency setting compared to olanzapine and haloperidol. Midazolam and olanzapine are preferred over haloperidol's slower time to sedation and potential for cardiovascular and extrapyramidal side effects. FUNDING: Research Grants Council, Hong Kong.