Prospective study of the safety and effectiveness of droperidol in elderly patients for pre‐hospital acute behavioural disturbance

Abstract

Objective: Acute behavioural disturbance in the elderly (≥65 years) is a significant issue for emergency medical services with increasing prevalence of dementia and aging populations. We investigated the pre-hospital safety and effectiveness of droperidol in the elderly with acute behavioural disturbance. Methods: This was a pre-hospital prospective observational 1-year study of elderly patients with acute behavioural disturbance. The primary outcome was proportion of adverse events (AEs) (airway intervention, oxygen saturation <90% and/or respiratory rate <12/min, systolic blood pressure <90 mmHg, sedation assessment tool score of −3 and dystonic reactions). Secondary outcomes included time to sedation, additional sedation, proportion with successful sedation. Results: There were 149 patients (males 78 [52%], median age 78 years; 65-101 years) presenting on 162 occasions. Dementia was the commonest cause (107/164 [65%]) of acute behavioural disturbance. There were six AEs in five patients (5/162 [3%]; 95% confidence interval 1-7). Three had hypotension, one with associated hypoxia (80%); and two had respiratory AEs (respiratory rate, 10/min [no hypoxia] and hypoxia [88%] which required oxygen). Median time to sedation was 19 min (interquartile range 12-29 min). Additional sedation was given in 2/162 patients during ambulance transfer and 16/162 within an hour of hospital arrival; 24/162 (15%) failed to sedate in the ambulance; 16 subsequently settled in ED and 8/24 received additional sedation. Of 162, 123 (76%) patients successfully sedated, without AEs or additional sedation. Of 162, 114 (70%) patients received 5 mg, 46 (29%) received two doses of 5 mg and two patients (1%) received three doses. Conclusions: Droperidol appeared to be safe and effective for prehospital sedation of acute behavioural disturbance in elderly patients.

Factors associated with paediatric and adolescent Emergency Department presentations involving acute behavioural disturbance events

“…2 In those aged over 65 years, dementia in combination with acute medical illness is most commonly the underlying cause. 3 There is however a paucity of data describing ABD in those under 18 years and the clinical factors associated with its occurrence. The use of physical restraint is commonly used as a proxy for ABD in a paediatric population.…”

“…Within the 18–65 year age group, such presentations have been commonly associated with acute drug intoxication 2 . In those aged over 65 years, dementia in combination with acute medical illness is most commonly the underlying cause 3 . There is however a paucity of data describing ABD in those under 18 years and the clinical factors associated with its occurrence.…”