Rescue Sedation after 5 mg or 10 mg of Droperidol as the Initial Treatment for Acute Agitation in the Emergency Department

Background

Droperidol is used commonly to treat agitation in the emergency department (ED), however, data comparing doses are lacking.

Objective

The aim of this study was to compare the effectiveness of 5 mg vs. 10 mg as initial droperidol dose for acute agitation in the ED.

Methods

This single-center, retrospective study examined adult ED patients receiving either 5 mg or 10 mg droperidol as the first agent to treat agitation from 2010 to 2023. The primary outcome was need for additional (rescue) sedation within 1 h of initial droperidol dose.

Results

The authors identified 11,568 patients who received droperidol as their first medication (n = 8603 [74%] via intramuscular route); 10,293 received 5 mg and 1275 received 10 mg. Median age was 39 years (interquartile range 28–50 years); 8372 (72%) were male. Rescue sedation within 1 h was administered to 987 patients (9.6%) in the 5-mg group and 189 patients (14.8%) in the 10-mg group (difference 5.2%; 95% CI 3.2–7.3%). Additional sedation at any time was administered to 1776 patients (17.3%) in the 5-mg group and 318 (24.9%) in the 10-mg group (difference 7.7%; 95% CI 5.2–10.2%). Median length of stay was 471 min (interquartile range 347–611 min) in the 5 mg group and 487 min (interquartile range 364–641 min) in the 10-mg group (median difference 24 min; 95% CI 11–37 min).

Conclusions

In this large cohort, patients deemed appropriately treated with 5 mg of droperidol required less rescue sedation than patients determined to need 10 mg.