title: The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department.
abstract: OBJECTIVE
  We investigate the safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department (ED).
  
  
  METHODS
  This was a prospective observational study in 6 EDs (August 2009 to April 2013). Adult patients requiring parenteral sedation for acute behavioral disturbance received droperidol 10 mg. If this did not sedate the patient within 15 minutes, further sedation was allowed but droperidol 10 mg was recommended as part of a sedation protocol. The primary outcome was the proportion of patients with an abnormal QT interval, defined by the at-risk line on the QT nomogram. Secondary outcomes were effectiveness determined by the time to sedation measured on the Sedation Assessment Tool, use of additional sedation, adverse events, and injury to staff or patients.
  
  
  RESULTS
  There were 1,009 patients with an ECG performed within 2 hours of droperidol administration, with a median dose of 10 mg (interquartile range [IQR]10 to 17.5 mg). Thirteen of the 1,009 patients had an abnormal QT (1.3%; 95% confidence interval 0.7% to 2.3%), but 7 of these had another cause attributed for prolonged QT (methadone, escitalopram, amiodarone, or preexisting). In 1,403 patients sedated with a median total dose of droperidol of 10 mg (IQR 10 to 20 mg), the median time to sedation was 20 minutes (IQR 10 to 30 minutes) and 97% were sedated within 120 minutes. Additional sedation was required for 435 patients (31.0%; 95% confidence interval 28.6% to 33.5%). Adverse events occurred in 70 patients (5%) and oversedation without complications in 109 (8%), the latter more common for patients receiving benzodiazepines as additional sedation (16/109 [15%]). There were no cases of torsades de pointes. Injuries occurred in 34 staff members and 4 patients.
  
  
  CONCLUSIONS
  The study supports the use of high-dose droperidol as a safe sedating agent for patients with acute behavioral disturbance in the ED. There is no evidence of increased risk for QT prolongation with the doses used in this study.
authors.affiliation: School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
authors.forename: Leonie
authors.initials: L
authors.lastname: Calver
authors.affiliation: Emergency Department, Princess Alexandra Hospital, Queensland, and the School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Colin B
authors.initials: CB
authors.lastname: Page
authors.affiliation: Emergency Department, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Downes
authors.affiliation: Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Betty
authors.initials: B
authors.lastname: Chan
authors.affiliation: Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Kinnear
authors.affiliation: Cairns Base Hospital, Cairns, Queensland, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Wheatley
authors.affiliation: Gold Coast and Robina Hospitals, Gold Coast, Queensland, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Spain
authors.affiliation: School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Emergency Department, Calvary Mater Newcastle, Newcastle, New South Wales, Australia. Electronic address: geoff.isbister@gmail.com.
authors.forename: Geoffrey Kennedy
authors.initials: GK
authors.lastname: Isbister
mesh_terms: D000328:Adult; D016292:Procedural Sedation / Q000379:methods*; D003617:Dangerous Behavior; D004329:Droperidol / Q000009:adverse effects / Q000627:therapeutic use*; D004562:Electrocardiography / Q000187:drug effects; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014754:Violence / Q000517:prevention & control
chemical_list: D006993:Hypnotics and Sedatives; D004329:Droperidol