The following is a summary of “Safety and effectiveness of benzodiazepines and antipsychotics for agitation in older adults in the emergency department,” published in the May 2023 issue of Emergency Medicine by Engstrom, et al.

For a study, researchers sought to evaluate the safety and effectiveness of benzodiazepines (BZD) compared to antipsychotics in managing acute agitation in older adults in the emergency department (ED).

A retrospective observational cohort study was conducted across 21 EDs in four states in the US. The study included adults aged 60 and older who received either BZD or antipsychotics for acute agitation in the ED and were subsequently admitted to the hospital. Safety was assessed based on adverse events, such as respiratory depression, cardiovascular effects, extrapyramidal side effects, or falls during hospitalization. Effectiveness was measured by treatment failure indicators, including the need for additional medication, one-to-one observation, or physical restraints after the initial medication administration. Proportions and odds ratios with 95% CI were calculated, and logistic regression analysis was used to assess the association between potential risk factors and efficacy and safety endpoints.

A total of 684 patients were included in the study, with 63.9% receiving BZD and 36.1% receiving antipsychotics. There was no significant difference in the incidence of adverse events between the two groups (20.6% vs. 14.6%, difference 6.0%, 95% CI -0.2% to 11.8%). However, the intubation rate was higher in the BZD group (2.7% vs. 0.4%, a difference of 2.3%). The antipsychotic group had a higher rate of treatment failures for the composite primary efficacy endpoint (94.3% vs. 87.6%, difference 6.7%, 95% CI 2.5% to 10.9%). The need for one-to-one observation drove the difference. Sensitivity analysis, excluding one-to-one observation from the composite outcome, showed no significant difference in treatment failure rates, with a failure rate of 38.5% in the antipsychotic group and 35.2% in the BZD group.

The study found high treatment failure rates among agitated older adults receiving pharmacological treatment for agitation in the ED. The selection of pharmacological treatment for agitation in the population should consider patient-specific factors that may increase the risk of adverse effects or treatment failure.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001006