Friday, September 23, 2005

Prophylactic haloperidol to reduce delirium

The current J of the American Geriatrics Society presents a randomized controlled trial of prophylactic haldol to prevent delirium in elderly hip fracture patients.  They randomized about 400 people >70 years old to haldol 0.5mg tid or placebo at the time of hospital admission & continued the haldol for 3 days after surgery; those who developed delirium were treated with a protocol using haldol & (interestingly) lorazepam; those who were assessing the patients for delirium were blinded to allocation; intention to treat analysis was used.  Rates of postoperative delirium were identical between groups (15%)--however the delirium was briefer (5 vs 11 days) and less severe in the haldol group, and the length of hospital stay (for those patients were developed delirium) was much shorter (17 vs 22 days) in the haldol group.  They state there were no treatment side effects from the prophylaxis but that seems really unlikely especially since there was no formal side effect assessment--they did state there were no extrapyramidal reactions observed.  This isn't exactly palliative medicine research but I think any randomized trial involving antipsychotics for delirium is of note since it is such a common practice in our lives & quality clinical trial data are sparse.
I will also commend this article for its use of the term "morphinomimetics."

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