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.