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dc.contributor.authordeSouza, Ian S
dc.contributor.authorThode, Henry C
dc.contributor.authorShrestha, Pragati
dc.contributor.authorAllen, Robert
dc.contributor.authorKoos, Jessica
dc.contributor.authorSinger, Adam J
dc.date.accessioned2023-01-23T16:44:40Z
dc.date.available2023-01-23T16:44:40Z
dc.date.issued2021-11-14
dc.identifier.citationdeSouza IS, Thode HC Jr, Shrestha P, Allen R, Koos J, Singer AJ. Rapid tranquilization of the agitated patient in the emergency department: A systematic review and network meta-analysis. Am J Emerg Med. 2022 Jan;51:363-373. doi: 10.1016/j.ajem.2021.11.011. Epub 2021 Nov 14. Erratum in: Am J Emerg Med. 2021 Nov 29;: PMID: 34823192.en_US
dc.identifier.eissn1532-8171
dc.identifier.doi10.1016/j.ajem.2021.11.011
dc.identifier.pmid34823192
dc.identifier.urihttp://hdl.handle.net/20.500.12648/8114
dc.description.abstractSafe and effective tranquilization of the acutely agitated patient is challenging, and head-to-head comparisons of medications are limited. We aimed to identify the most optimal agent(s) for rapid tranquilization of the severely agitated patient in the emergency department (ED).
dc.description.abstractThe protocol for systematic review was registered (PROSPERO; CRD42020212534). We searched MEDLINE, Embase, PsycINFO, and Cochrane Database/CENTRAL from inception to June 2, 2021. We limited studies to randomized controlled trials that enrolled adult ED patients with severe agitation and compared drugs for rapid tranquilization. Predetermined outcomes were: 1) Adequate sedation within 30 min (effectiveness), 2) Immediate, serious adverse event - cardiac arrest, ventricular tachydysrhythmia, endotracheal intubation, laryngospasm, hypoxemia, hypotension (safety), and 3) Time to adequate sedation (effect onset). We extracted data according to PRISMA-NMA and appraised trials using Cochrane RoB 2 tool. We performed Bayesian network meta-analysis (NMA) using a Markov Chain Monte Carlo method with random-effects model and vague prior distribution to calculate odds ratios with 95% credible intervals for dichotomous outcomes and frequentist NMA to calculate mean differences with 95% confidence intervals for continuous outcomes. We assessed confidence in results using CINeMA. We used surface under the cumulative ranking (SUCRA) curves to rank agent(s) for each outcome.
dc.description.abstractEleven studies provided data for effectiveness (1142 patients) and safety (1147 patients). Data was insufficient for effect onset. The NMA found that ketamine (SUCRA = 93.0%) is most likely to have superior effectiveness; droperidol-midazolam (SUCRA = 78.8%) is most likely to be safest. There are concerns with study quality and imprecision. Quality of the point estimates varied for effectiveness but mostly rated "very low" for safety.
dc.description.abstractAvailable evidence suggests that ketamine and droperidol have intermediate effectiveness for rapid tranquilization of the severely agitated patient in the ED. There is insufficient evidence to definitively determine which agent(s) may be safest or fastest-acting. Further, direct-comparison study of ketamine and droperidol is recommended.
dc.language.isoenen_US
dc.relation.urlhttps://www.sciencedirect.com/science/article/abs/pii/S0735675721009153en_US
dc.rightsCopyright © 2021 Elsevier Inc. All rights reserved.
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectAgitationen_US
dc.subjectDeliriumen_US
dc.subjectNetwork meta-analysisen_US
dc.subjectSedationen_US
dc.subjectTranquilizationen_US
dc.titleRapid tranquilization of the agitated patient in the emergency department: A systematic review and network meta-analysis.en_US
dc.typeArticle/Reviewen_US
dc.source.journaltitleThe American journal of emergency medicineen_US
dc.source.volume51
dc.source.beginpage363
dc.source.endpage373
dc.source.countryUnited States
dc.description.versionVoRen_US
refterms.dateFOA2023-01-23T16:44:41Z
html.description.abstractSafe and effective tranquilization of the acutely agitated patient is challenging, and head-to-head comparisons of medications are limited. We aimed to identify the most optimal agent(s) for rapid tranquilization of the severely agitated patient in the emergency department (ED).
html.description.abstractThe protocol for systematic review was registered (PROSPERO; CRD42020212534). We searched MEDLINE, Embase, PsycINFO, and Cochrane Database/CENTRAL from inception to June 2, 2021. We limited studies to randomized controlled trials that enrolled adult ED patients with severe agitation and compared drugs for rapid tranquilization. Predetermined outcomes were: 1) Adequate sedation within 30 min (effectiveness), 2) Immediate, serious adverse event - cardiac arrest, ventricular tachydysrhythmia, endotracheal intubation, laryngospasm, hypoxemia, hypotension (safety), and 3) Time to adequate sedation (effect onset). We extracted data according to PRISMA-NMA and appraised trials using Cochrane RoB 2 tool. We performed Bayesian network meta-analysis (NMA) using a Markov Chain Monte Carlo method with random-effects model and vague prior distribution to calculate odds ratios with 95% credible intervals for dichotomous outcomes and frequentist NMA to calculate mean differences with 95% confidence intervals for continuous outcomes. We assessed confidence in results using CINeMA. We used surface under the cumulative ranking (SUCRA) curves to rank agent(s) for each outcome.
html.description.abstractEleven studies provided data for effectiveness (1142 patients) and safety (1147 patients). Data was insufficient for effect onset. The NMA found that ketamine (SUCRA = 93.0%) is most likely to have superior effectiveness; droperidol-midazolam (SUCRA = 78.8%) is most likely to be safest. There are concerns with study quality and imprecision. Quality of the point estimates varied for effectiveness but mostly rated "very low" for safety.
html.description.abstractAvailable evidence suggests that ketamine and droperidol have intermediate effectiveness for rapid tranquilization of the severely agitated patient in the ED. There is insufficient evidence to definitively determine which agent(s) may be safest or fastest-acting. Further, direct-comparison study of ketamine and droperidol is recommended.
dc.description.institutionSUNY Downstateen_US
dc.description.departmentEmergency Medicineen_US
dc.description.degreelevelN/Aen_US
dc.identifier.journalThe American journal of emergency medicine


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