Derailing the myth of the droperidol dangers

Abstract

Study objectives: In 2001, a US Food and Drug Administration “black box warning” forced many health care facilities to abandon the use of droperidol. We describe the use of droperidol in emergency department (ED) patients in the 4 years preceding the black box warning. Methods: This was a secondary analysis of the 1997 to 2000 National Hospital Ambulatory Medical Survey (NHAMCS), a probability sample of ED visits in the United States. All cases in which “droperidol” or “Inapsine” was used were identified. Complications were assessed by identifying cases of arrhythmia, death, intubation, or use of antiarrhythmic agents in the ED (lidocaine, amiodarone, or isoproterenol). Univariate analysis was conducted using SAS software (version 8.02). Multivariate modeling and clustered analysis are ongoing. Results: Approximately 1.6 million patients (0.4% of all visits) received droperidol in the ED between 1997 and 2000. Nausea, vomiting, and abdominal pain were the most common reasons for visiting the ED (39.4%), followed by headache (9.0%) and vertigo (4.8%). Patients receiving droperidol were older (42.8 versus 35.2 years; P<.0001) in comparison to all ED patients; 59% were women and 84.8% white. Patients receiving droperidol were also more likely to have an ECG (21.4% versus 14.6%; P<.0003), cardiac monitoring (15.5% versus 8.0%; P<.0001), CBC count (55.5% versus 25.1%; P<.0001), intravenous fluids (69% versus 17.3%; P<.0001), and computed tomography scan (11.8% versus 4.2%; P<.0001). Admission rate for patients receiving droperidol was 24.5% versus 13.4% for patients not receiving droperidol (P<.0001). None were intubated, required cardiopulmonary resuscitation, or died while in the ED (proportion=0; 95% confidence interval 0.00 to 0.0084). No patients received anti-arrhythmic agents used for polymorphic or monomorphic ventricular tachycardia. Conclusion: Although the complication rate is likely to be greater than zero, the NHAMCS database suggests that droperidol has been used widely in the ED with an excellent safety profile. Patients receiving droperidol were older and more likely to have a greater severity of illness than all other patients in the ED. Study objectives: In 2001, a US Food and Drug Administration “black box warning” forced many health care facilities to abandon the use of droperidol. We describe the use of droperidol in emergency department (ED) patients in the 4 years preceding the black box warning. Methods: This was a secondary analysis of the 1997 to 2000 National Hospital Ambulatory Medical Survey (NHAMCS), a probability sample of ED visits in the United States. All cases in which “droperidol” or “Inapsine” was used were identified. Complications were assessed by identifying cases of arrhythmia, death, intubation, or use of antiarrhythmic agents in the ED (lidocaine, amiodarone, or isoproterenol). Univariate analysis was conducted using SAS software (version 8.02). Multivariate modeling and clustered analysis are ongoing. Results: Approximately 1.6 million patients (0.4% of all visits) received droperidol in the ED between 1997 and 2000. Nausea, vomiting, and abdominal pain were the most common reasons for visiting the ED (39.4%), followed by headache (9.0%) and vertigo (4.8%). Patients receiving droperidol were older (42.8 versus 35.2 years; P<.0001) in comparison to all ED patients; 59% were women and 84.8% white. Patients receiving droperidol were also more likely to have an ECG (21.4% versus 14.6%; P<.0003), cardiac monitoring (15.5% versus 8.0%; P<.0001), CBC count (55.5% versus 25.1%; P<.0001), intravenous fluids (69% versus 17.3%; P<.0001), and computed tomography scan (11.8% versus 4.2%; P<.0001). Admission rate for patients receiving droperidol was 24.5% versus 13.4% for patients not receiving droperidol (P<.0001). None were intubated, required cardiopulmonary resuscitation, or died while in the ED (proportion=0; 95% confidence interval 0.00 to 0.0084). No patients received anti-arrhythmic agents used for polymorphic or monomorphic ventricular tachycardia. Conclusion: Although the complication rate is likely to be greater than zero, the NHAMCS database suggests that droperidol has been used widely in the ED with an excellent safety profile. Patients receiving droperidol were older and more likely to have a greater severity of illness than all other patients in the ED.