Comparative Safety of Medications for Severe Agitation: A Geriatric Emergency Department Guidelines 2.0 Systematic Review DOI Creative Commons
Martin F. Casey, Natalie M. Elder, Alexander Fenn

et al.

Journal of the American Geriatrics Society, Journal Year: 2025, Volume and Issue: unknown

Published: April 24, 2025

ABSTRACT Background Managing undifferentiated, severe agitation in older adults may require antipsychotic or sedative medications to prevent harm self others. Unfortunately, these are associated with serious adverse events adults, and little is known about their comparative safety. Methods We conducted a systematic review identify effectiveness studies on the safety of used treatment among prehospital emergency department (ED) setting. searched eight databases including PubMed, EMBASE, SCOPUS, Cochrane library, CINAHL, Proquest Central, Ageline, PsycInfo published before February 2024. Studies were included if they examined 1st generation antipsychotics, 2nd benzodiazepines, ketamine. Data extracted respiratory (apnea, hypoxemia, intubation) other (arrhythmia, hypotension, worsening delirium, cardiac arrest, mortality). report aggregate occurrence any pooled by drug odds ratios (ORs) using haloperidol as reference group. Results Among 8600 identified, observational one randomized clinical trial met eligibility for further qualitative quantitative analysis. The 838 receiving ( n = 117), droperidol 129), lorazepam 350), midazolam 68), olanzapine 101), quetiapine 56), ziprasidone 17). Any observed 16.8% patients (141/838). Adverse most common (53%; 36/68). Relative haloperidol, significantly increased risk (OR 5.25 [95% CI: 2.64–10.45]). Quetiapine was only have lower frequency 0.27 0.08, 0.97]). Conclusions anxiolytic agitation. Benzodiazepines, particularly midazolam, pose an excessive requiring pharmacologic

Language: Английский

Prevalence and Risk Factors for Delirium on Arrival at the Emergency Room by Ambulance DOI Open Access
Hideaki Sakuramoto,

Jumpei Onuma,

Shogo Uno

et al.

Cureus, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 25, 2025

Delirium is an acute and often fluctuating disturbance in attention awareness one of the organ dysfunctions caused by illness. A previous study revealed that 8.3% older patients emergency room (ER) had delirium, dementia age were identified as independent risk factors for delirium ER. However, different ER structures (intermediate or care units) disease clusters may have prevalence rates factors. This aimed to identify on arrival at was exploratory clinical trial retrospective cohort conducted a tertiary center Japan, including aged ≥20 years who transported hospitalized between April 1, 2023, March 31, 2024. evaluated using Brief Confusion Assessment Method. Multivariate analysis performed 12 variables significantly comparison patient characteristics upon Of 20,660 visited ER, 1,486 ambulance included this study. The 20.3% (301/1486 patients, 95% confidence intervals: 18.2-22.4). Multivariable logistic regression significant association (odds ratio (OR) 1.02, interval (CI) 1.01-1.04), past history (OR 3.94, 95%CI 2.41-6.44) psychiatric illness 2.76, 1.41-5.40), higher Glasgow Coma Scale (GCS) scores 0.34, 0.29-0.40), requiring oxygen therapy 2.09, 1.45-3.02). approximately 20%. Our findings suggest age, illness, low GCS score presentation, need be symptoms presentation.

Language: Английский

Citations

0
Acute Delirium From Urinary Retention in Elderly Women With Alzheimer’s Disease: A Case of Female Cystocerebral Syndrome DOI
Mang OuYang,

Yao Zeng

Journal of Emergency Nursing, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Language: Английский

Citations

0
Comparative Safety of Medications for Severe Agitation: A Geriatric Emergency Department Guidelines 2.0 Systematic Review DOI Creative Commons
Martin F. Casey, Natalie M. Elder, Alexander Fenn

et al.

Journal of the American Geriatrics Society, Journal Year: 2025, Volume and Issue: unknown

Published: April 24, 2025

ABSTRACT Background Managing undifferentiated, severe agitation in older adults may require antipsychotic or sedative medications to prevent harm self others. Unfortunately, these are associated with serious adverse events adults, and little is known about their comparative safety. Methods We conducted a systematic review identify effectiveness studies on the safety of used treatment among prehospital emergency department (ED) setting. searched eight databases including PubMed, EMBASE, SCOPUS, Cochrane library, CINAHL, Proquest Central, Ageline, PsycInfo published before February 2024. Studies were included if they examined 1st generation antipsychotics, 2nd benzodiazepines, ketamine. Data extracted respiratory (apnea, hypoxemia, intubation) other (arrhythmia, hypotension, worsening delirium, cardiac arrest, mortality). report aggregate occurrence any pooled by drug odds ratios (ORs) using haloperidol as reference group. Results Among 8600 identified, observational one randomized clinical trial met eligibility for further qualitative quantitative analysis. The 838 receiving ( n = 117), droperidol 129), lorazepam 350), midazolam 68), olanzapine 101), quetiapine 56), ziprasidone 17). Any observed 16.8% patients (141/838). Adverse most common (53%; 36/68). Relative haloperidol, significantly increased risk (OR 5.25 [95% CI: 2.64–10.45]). Quetiapine was only have lower frequency 0.27 0.08, 0.97]). Conclusions anxiolytic agitation. Benzodiazepines, particularly midazolam, pose an excessive requiring pharmacologic

Language: Английский

Citations

0