A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance

<b>Study Objective</b>: Acute behavioral disturbance is a common problem for emergency medical services. We aimed to investigate the safety and effectiveness of droperidol compared to midazolam in the prehospital setting. <b>Methods</b>: This was a prospective before and after study comparing droperidol to midazolam for prehospital acute behavioral disturbance, when the state ambulance service changed medications. The primary outcome was the proportion of adverse effects (airway intervention, oxygen saturation &lt; 90%, respiratory rate &lt; 12, systolic blood pressure &lt; 90 mmHg, sedation assessment tool score −3 and dystonic reactions) in patients receiving sedation. Secondary outcomes included time to sedation, requirement for additional sedation, staff and patient injuries, and prehospital time. <b>Results</b>: There were 141 patients administered midazolam and 149 patients administered droperidol in the study. Alcohol was the most common cause of acute behavioral disturbance. Fewer patient adverse events occurred with droperidol (11/149) compared to midazolam (33/141) (7% vs. 23%; absolute difference 16%; 95% confidence interval [CI]: 8% to 24%; p = 0.0001). Median time to sedation was 22 min (interquartile range [IQR]:18 to 35 min) for droperidol compared to 30 min (IQR:20 to 45 min) for midazolam. Additional prehospital sedation was required in 6/149 (4%) droperidol patients and 20/141 (14%) midazolam patients, and 11 (7%) droperidol and 59 (42%) midazolam patients required further sedation in the emergency department. There were no differences in patient or staff injuries, or prehospital time. <b>Conclusions</b>: The use of droperidol for acute behavioral disturbance in the prehospital setting is associated with fewer adverse events, a shorter time to sedation, and fewer requirements for additional sedation.

<b>研究目标</b>: 急性行为障碍（acute behavioral disturbance）是急诊医疗服务中的常见问题。本研究旨在探讨院前环境（prehospital setting）中，氟哌利多（droperidol）对比咪达唑仑（midazolam）的安全性与有效性。<b>研究方法</b>: 本研究为一项前瞻性前后对照研究（prospective before and after study），在州级急救医疗服务机构更换镇静药物期间，对比氟哌利多与咪达唑仑用于院前急性行为障碍患者的疗效。主要结局指标为接受镇静治疗患者的不良事件发生率，包括气道干预、血氧饱和度＜90%、呼吸频率＜12次/分、收缩压＜90mmHg、镇静评估工具（sedation assessment tool）评分降至-3及肌张力障碍反应（dystonic reactions）。次要结局指标包括镇静起效时间、额外镇静给药需求、医护人员与患者损伤情况及院前救治时长。<b>研究结果</b>: 本研究共纳入141例接受咪达唑仑治疗的患者，以及149例接受氟哌利多治疗的患者。酒精是引发急性行为障碍的最常见诱因。氟哌利多组不良事件发生率（11/149，7%）显著低于咪达唑仑组（33/141，23%），绝对差值为16%，95%置信区间（confidence interval，CI）为8%~24%（p=0.0001）。氟哌利多组的镇静起效中位时间为22分钟，四分位距（interquartile range，IQR）为18~35分钟；咪达唑仑组的镇静起效中位时间为30分钟，IQR为20~45分钟。院前需额外镇静给药的患者比例，氟哌利多组为6/149（4%），咪达唑仑组为20/141（14%）；急诊科室需进一步镇静的患者比例，氟哌利多组为11例（7%），咪达唑仑组为59例（42%）。两组在患者或医护人员损伤情况、院前救治时长方面均无显著差异。<b>研究结论</b>: 院前环境中使用氟哌利多治疗急性行为障碍，可降低不良事件发生率、缩短镇静起效时间，并减少额外镇静给药的需求。