Management of acute agitation in Hong Kong and comparisons with Australasia

Esther Wai Yin Chan; Cedric Tang; Kim Shi Jian Lao; Leung Ling Pong; Matthew Sik Hon Tsui; Hiu Fai Ho; Gordon Chi Keung Wong; David Chee Ming Kong; David McD Taylor; Jonathan C Knott; Ian Chi Kei Wong

doi:10.1111/1742-6723.12499

Management of acute agitation in Hong Kong and comparisons with Australasia

Emerg Med Australas. 2015 Dec;27(6):542-548. doi: 10.1111/1742-6723.12499. Epub 2015 Dec 3.

Authors

Affiliations

¹ Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong.
² School of Pharmacy, University College London, London, UK.
³ Emergency Medicine Unit, , The University of Hong Kong, Pokfulam, Hong Kong.
⁴ Department of Accident and Emergency, Queen Mary Hospital, Pokfulam, Hong Kong.
⁵ Department of Accident and Emergency, Queen Elizabeth Hospital, King's Park, Hong Kong.
⁶ Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.
⁷ Emergency Department, Austin Health, Melbourne, Victoria, Australia.
⁸ Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁹ Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.

PMID: 26635127
DOI: 10.1111/1742-6723.12499

Abstract

Background: Little is known about the use of sedation drugs for the management of acute agitation in Hong Kong's Accident and Emergency Departments (AEDs) and how it compares with Australasian practice.

Objective: The aim of this study was to determine drug preferences, clinicians' perceived confidence in management, barriers/gaps in training and perceived usefulness of existing clinical practice guidelines (CPGs) in Hong Kong.

Method: A validated questionnaire was used, with case vignettes typical of patients presenting to AEDs with acute agitation. The questionnaire was distributed by hand to all trainees and fellows of the Hong Kong College of Emergency Medicine (HKCEM). Two reminders were sent.

Results: Of 483 HKCEM members, 280 (58.0% [95% CI 53.5-62.3]) responded. For monotherapy, 46.8% (95% CI 41.0-52.6) of respondents chose haloperidol to manage the undifferentiated patient, followed by midazolam (33.9%, 95% CI 28.6-39.7) and diazepam (13.9%, 95% CI 10.4-18.5). Most respondents (83.6%, 95% CI 78.8-87.5) would not administer combination therapy. Respondents were confident in managing agitation overall. The lack of local/institutional CPGs (55.7%, 95% CI 49.9-61.4) was perceived as an important barrier. Institutional guidelines were considered the most useful CPGs (66.4%, 95% CI 60.7-71.7). Most respondents (72.9%, 95% CI 67.4-77.7) perceived a HKCEM endorsed CPG would be useful.

Conclusion: Haloperidol and benzodiazepines are frequently used as monotherapy for the management of acute agitation in Hong Kong's AEDs. Management in Hong Kong differs from Australasian practice in that combination therapy is less common and clinicians' choice of sedation drugs are less variable overall. Results suggest that future work on CPG development and training regarding the safe use of combination therapy would be well received.

Keywords: aggression; emergency medicine; pharmaceutical preparations; questionnaires; violence.