Summary of findings 3. Droperidol versus midazolam.
| Droperidol versus midazolam | ||||||
|
Patient or population: acute psychosis Setting: inpatient Intervention: droperidol Comparison: midazolam | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with midazolam | Risk with droperidol | |||||
| Tranquillisation or asleep: tranquillised/asleep ‐ by 30 minutes (at 10 minutes) | Moderate | RR 0.96 (0.72 to 1.28) | 153 (1 RCT) | ⊕⊕⊕⊕ High 1 | 'Moderate' control risk approximately that of trial population. | |
| 550 per 1000 | 528 per 1000 (396 to 704) | |||||
| Global state: use of additional medication ‐ by 60 minutes after initial adequate sedation until ED discharge (various psychotropic drugs) | Moderate | RR 0.54 (0.24 to 1.20) | 153 (1 RCT) | ⊕⊕⊕⊝ Moderate 1,2 | 'Moderate' control risk approximately that of trial population. | |
| 190 per 1000 | 101 per 1000 (42 to 224) | |||||
| Adverse effects ‐ respiratory ‐ airway obstruction | Moderate | RR 0.13 (0.01 to 2.55) | 153 (1 RCT) | ⊕⊕⊝⊝ Low 1,2,3 | 'Moderate' control risk approximately that of trial population. | |
| 40 per 1000 | 5 per 1000 (0 to 102) | |||||
| Adverse effects ‐ respiratory ‐ hypoxia | Moderate | RR 0.70 (0.16 to 3.03) | 153 (1 RCT) | ⊕⊕⊕⊝ Moderate 1,2 | 'Moderate' control risk approximately that of trial population. | |
| 50 per 1000 | 35 per 1000 (8 to 143) | |||||
| Service use: person able to be discharged home | Study population | Not estimable | (0 studies) | ‐ | No trial reported this important outcome. | |
| Not pooled | Not pooled | |||||
| Mental state ‐ improvement | Study population | Not estimable | (0 studies) | ‐ | No trial reported this important outcome. | |
| Not pooled | Not pooled | |||||
| Economic: direct costs | Study population | Not estimable | (0 studies) | ‐ | No trial reported this important outcome. | |
| Not pooled | Not pooled | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; ED: emergency department; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Risk of bias: rated 'not serious' (no downgrade) ‐ clear reporting of good methods.
2 Imprecision: rated 'serious' (downgraded by 1) ‐ few events, wide confidence intervals.
3 Indirectness: rated 'serious' (downgraded by 1) ‐ respiratory obstruction proxy measure ‐ not 'death'.