(PO-155) (PO-155) Efficacy and Safety of Droperidol for Management of Acute Agitation in the Emergency Department

Background/Significance:
Droperidol has been demonstrated to be an effective treatment for acute agitation in the emergency department (ED), with some data suggesting it to be superior to haloperidol (Thomas, 1992). However, QT prolongation concerns resulted in an FDA black-box warning in 2001, and its use by emergency physicians diminished. In 2019, a generic manufacturer began to produce droperidol for injection, now making it easier to obtain, but lack of current data is likely contributing to hesitancy in again adopting droperidol into the arsenal for acute agitation management (Mattson, 2020). We sought to provide ED experience data that supports droperidol’s safety and efficacy in acute agitation management.

Methods:
A retrospective chart review will be conducted on patients that present to Lahey Hospital and Medical Center's ED from January 5, 2021 to September 5, 2021. Patients will be included if they are ≥18 years of age and received droperidol for agitation. All visits will be treated as a separate entry. A report through the electronic medical record (EMR) system will be completed to determine any patient that received droperidol in the ED.

Data collected include droperidol dose, route of administration, QTc (if applicable - collected if taken before or after administration), if the patient required repeat doses of droperidol, and other medications given to the patient within 12 hours of droperidol administration.

Results:
At the time of submission, 17 patients (average age 39, range 19-81) have received at least one dose of droperidol (2.5mg or 5mg), with 71% receiving it intramuscularly and 29% receiving it intravenously, all for acute agitation. QTc was obtained on 59% prior to administration and 59% after, without significant prolongation. Further data to be obtained include overall safety including cardiac events, incidence of requiring a second dose, incidence of requiring additional psychiatric medication administration and ED length of stay. This study is ongoing and further results are pending.

Discussion:
At the time of submission, our experience has supported the safety of droperidol at doses of 2.5-5mg, which we anticipate will be more strongly supported by higher numbers of patients and more robust data by the completion of this study. We also anticipate demonstration of efficacy in controlling acute agitation.

Conclusion/Implications:
Given the likely barrier to practice of minimal current data on droperidol for acute agitation in the ED, we anticipate this data will be of importance to the practicing emergency psychiatrist in supporting the ED to improve the practice of management of acute agitation.

References:
Thomas H Jr et al. Droperidol versus haloperidol for chemical restraint of agitated and combative patients. Ann Emerg Med, 1992. 21(4):407-413.
Mattson A et al. Reintegrating droperidol into emergency medicine practice. Am J Health-Syst Pharm, 2020. 77(22):1838–1845.