Efficacy of Combination Haloperidol, Lorazepam, and Diphenhydramine vs. Combination Haloperidol and Lorazepam in the Treatment of Acute Agitation: A Multicenter Retrospective Cohort Study
dc.contributor.author | Jeffers, Trevor | |
dc.contributor.author | Darling, Brenna | |
dc.contributor.author | Edwards, Christopher | |
dc.contributor.author | Vadiei, Nina | |
dc.date.accessioned | 2022-04-07T18:00:41Z | |
dc.date.available | 2022-04-07T18:00:41Z | |
dc.date.issued | 2022-03 | |
dc.identifier.citation | Jeffers, T., Darling, B., Edwards, C., & Vadiei, N. (2022). Efficacy of Combination Haloperidol, Lorazepam, and Diphenhydramine vs. Combination Haloperidol and Lorazepam in the Treatment of Acute Agitation: A Multicenter Retrospective Cohort Study. Journal of Emergency Medicine. | en_US |
dc.identifier.issn | 0736-4679 | |
dc.identifier.doi | 10.1016/j.jemermed.2022.01.009 | |
dc.identifier.uri | http://hdl.handle.net/10150/663898 | |
dc.description.abstract | Background: Antipsychotic and sedative combinations are commonly used for treating agitation in the emergency department despite limited evidence regarding their comparative safety and efficacy. Objectives: To compare the efficacy and safety of combination haloperidol, lorazepam, and diphenhydramine (B52) to combination haloperidol and lorazepam (52) in treating acute agitation. Methods: This multicenter, retrospective cohort study included adult patients ≥ 18 years of age who received either B52 or 52 at a Banner Health facility between August 2017 and September 2020. Patients were excluded if they had a pre-existing movement disorder or were withdrawing from alcohol. The primary outcome was administration of additional agitation medication(s) within 2 h of B52 or 52. Secondary outcomes included incidence of extrapyramidal symptoms, length of stay, and additional safety measures. Results: There was no difference in administration frequency of additional agitation medication(s) (B52: n = 28 [14%] vs. 52: n = 40 [20%]; p = 0.11). Patients who received 52 were more likely to require an antimuscarinic medication within 2 days (15 vs. 6 patients, p = 0.04). Of the patients who received an antimuscarinic medication, none had documented extrapyramidal symptoms. The 52 group had shorter length of stay (13.8 vs. 17 h; p = 0.03), lower incidence of hypotension (7 vs. 32 patients; p < 0.001), and oxygen desaturation (0 vs. 6 patients; p = 0.01), and fewer physical restraints (53 vs. 86 patients; p = 0.001) compared with the B52 group. Conclusions: Both the B52 and 52 combinations infrequently required repeat agitation medication; however, the B52 combination resulted in more oxygen desaturation, hypotension, physical restraint use, and longer length of stay. | en_US |
dc.language.iso | en | en_US |
dc.publisher | Elsevier BV | en_US |
dc.rights | © 2022 Published by Elsevier Inc. | en_US |
dc.rights.uri | http://rightsstatements.org/vocab/InC/1.0/ | en_US |
dc.subject | 52 | en_US |
dc.subject | agitation | en_US |
dc.subject | antipsychotic | en_US |
dc.subject | B52 | en_US |
dc.subject | benzodiazepine | en_US |
dc.subject | efficacy | en_US |
dc.subject | emergency department | en_US |
dc.subject | extrapyramidal symptoms | en_US |
dc.subject | pharmacotherapy | en_US |
dc.subject | safety | en_US |
dc.title | Efficacy of Combination Haloperidol, Lorazepam, and Diphenhydramine vs. Combination Haloperidol and Lorazepam in the Treatment of Acute Agitation: A Multicenter Retrospective Cohort Study | en_US |
dc.type | Article | en_US |
dc.contributor.department | Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy | en_US |
dc.contributor.department | Department of Emergency Medicine, University of Arizona College of Medicine | en_US |
dc.contributor.department | Department of Psychiatry, University of Arizona College of Medicine | en_US |
dc.identifier.journal | Journal of Emergency Medicine | en_US |
dc.description.note | 12 month embargo; available online: 12 March 2022 | en_US |
dc.description.collectioninformation | This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu. | en_US |
dc.eprint.version | Final accepted manuscript | en_US |
dc.identifier.pii | S0736467922000579 | |
dc.source.journaltitle | The Journal of Emergency Medicine |