title: Management of acute agitation in Hong Kong and comparisons with Australasia.
abstract: BACKGROUND
  Little is known about the use of sedation drugs for the management of acute agitation in Hong Kong's Accident and Emergency Departments (AEDs) and how it compares with Australasian practice.
  
  
  OBJECTIVE
  The aim of this study was to determine drug preferences, clinicians' perceived confidence in management, barriers/gaps in training and perceived usefulness of existing clinical practice guidelines (CPGs) in Hong Kong.
  
  
  METHODS
  A validated questionnaire was used, with case vignettes typical of patients presenting to AEDs with acute agitation. The questionnaire was distributed by hand to all trainees and fellows of the Hong Kong College of Emergency Medicine (HKCEM). Two reminders were sent.
  
  
  RESULTS
  Of 483 HKCEM members, 280 (58.0% [95% CI 53.5-62.3]) responded. For monotherapy, 46.8% (95% CI 41.0-52.6) of respondents chose haloperidol to manage the undifferentiated patient, followed by midazolam (33.9%, 95% CI 28.6-39.7) and diazepam (13.9%, 95% CI 10.4-18.5). Most respondents (83.6%, 95% CI 78.8-87.5) would not administer combination therapy. Respondents were confident in managing agitation overall. The lack of local/institutional CPGs (55.7%, 95% CI 49.9-61.4) was perceived as an important barrier. Institutional guidelines were considered the most useful CPGs (66.4%, 95% CI 60.7-71.7). Most respondents (72.9%, 95% CI 67.4-77.7) perceived a HKCEM endorsed CPG would be useful.
  
  
  CONCLUSIONS
  Haloperidol and benzodiazepines are frequently used as monotherapy for the management of acute agitation in Hong Kong's AEDs. Management in Hong Kong differs from Australasian practice in that combination therapy is less common and clinicians' choice of sedation drugs are less variable overall. Results suggest that future work on CPG development and training regarding the safe use of combination therapy would be well received.
authors.affiliation: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Esther Wai Yin
authors.initials: EW
authors.lastname: Chan
authors.affiliation: School of Pharmacy, University College London, London, UK.
authors.forename: Cedric
authors.identifier: http://orcid.org/0000-0002-6089-5702
authors.initials: C
authors.lastname: Tang
authors.affiliation: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Kim Shi Jian
authors.initials: KS
authors.lastname: Lao
authors.affiliation: Emergency Medicine Unit, , The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Leung
authors.initials: L
authors.lastname: Ling Pong
authors.affiliation: Department of Accident and Emergency, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Matthew Sik Hon
authors.initials: MS
authors.lastname: Tsui
authors.affiliation: Department of Accident and Emergency, Queen Elizabeth Hospital, King's Park, Hong Kong.
authors.forename: Hiu Fai
authors.initials: HF
authors.lastname: Ho
authors.affiliation: Department of Accident and Emergency, Queen Elizabeth Hospital, King's Park, Hong Kong.
authors.forename: Gordon Chi Keung
authors.initials: GC
authors.lastname: Wong
authors.affiliation: Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
authors.forename: David Chee Ming
authors.initials: DC
authors.lastname: Kong
authors.affiliation: Emergency Department, Austin Health, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: McD Taylor
authors.affiliation: Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Knott
authors.affiliation: Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong.|Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
authors.forename: Ian Chi Kei
authors.initials: IC
authors.lastname: Wong
keywords: aggression; emergency medicine; pharmaceutical preparations; questionnaires; violence