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Trial registered on ANZCTR
Registration number
ACTRN12611000565943
Ethics application status
Approved
Date submitted
12/05/2011
Date registered
2/06/2011
Date last updated
6/11/2014
Type of registration
Prospectively registered
Titles & IDs
Public title
A randomised controlled trial for the management of acute behavioural disturbance comparing haloperidol versus droperidol for the most effective sedation in psychiatric intensive care patients.
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Scientific title
A randomised controlled trial for the management of acute behavioural disturbance comparing haloperidol versus droperidol for the most effective sedation in the psychiatric intensive care patient.
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Secondary ID [1]
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Nil
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Universal Trial Number (UTN)
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Trial acronym
H.O.R.D.
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Acute behavioural disturbance
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Condition category
Condition code
Mental Health
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0
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Psychosis and personality disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Randomised controlled trial comparing the administration of haloperidol 10mg (arm 1)or droperidol 10mg (arm 2 ) for acute behavioural disturbance. Intramuscular injection of same single initial dose only.
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Intervention code [1]
264570
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Treatment: Drugs
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Comparator / control treatment
2 arms only. Nil placebo. Nil combination.
Arm 1:Haloperidol 10mg
Arm 2:Droperidol 10mg
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Control group
Active
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Outcomes
Primary outcome [1]
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1.Time from the administration of trial drug until sedation is achieved, determined by score on the Sedation Assessment Tool ( SAT) being reduced by two points or returned to zero (calm and alert).
Not a validated tool.
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Assessment method [1]
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Timepoint [1]
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From the time of administration of the study drug until sedation is achieved.
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Secondary outcome [1]
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1.The frequency of adverse drug effects:
a. Oxygen desaturation < 90%
b. Airway obstruction
c. Hypotension (systolic BP < 90 mmHg)
d. Extrapyramidal side-effects
a,b and c are normal vital signs monitoring and are recorded routinely on the observation chart and data sheets. Extrapyramidal side effects are an observation made by clinicians and/or recorded and treated due to patient discomfort.
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Assessment method [1]
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Timepoint [1]
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From the time of administration of the study drug until 1 hour post dose for a.b.c and d.
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Secondary outcome [2]
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2.Requirement for additional parenteral sedation as per the Sedation Assessment Tool ( SAT) score of +2 or +3 after 15 minutes after the initial administration.
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Assessment method [2]
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Timepoint [2]
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From the time of administration of the study drug until 4 hours post dose
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Secondary outcome [3]
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3.Incidence of injuries to the patients or staff members, as reported by members of staff.
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Assessment method [3]
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Timepoint [3]
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From the time of administration of the study drug until 4 hours post dose
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Eligibility
Key inclusion criteria
1.Psychiatric intensive care patients with acute behavioural disturbance at risk to themselves or others;
AND
2.Require being placed in seclusion or physical restraint to protect themselves and others
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Minimum age
18
Years
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Maximum age
100
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1.Patients who are willing to take oral medication for sedation without physical restraint or seclusion;
2.Patients under the age of 18 years of age
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
All psychiatric intensive care staff and associated mental health care workers will be made aware of the study with education sessions. When patients require sedation for acute behavioural disturbance recruitment will be based on inclusion and exclusion criteria and clinical judgement.The allocation of the 2 arms of the study are double blinded. The allocation is concealed by numbered identical containers.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
All psychiatric intensive care staff and associated mental health care workers will be made aware of the study with education sessions. When patients require sedation for acute behavioural disturbance recruitment will be based on inclusion and exclusion criteria and clinical judgement. Randomised pre-packed study kits will be available. The randomisation process used for this a computerised sequence generation Each kit will have one vial randomised to contain either:
1.10mg droperidol in 2mL
2.10 mg haloperidol in 2mL
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/07/2011
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Actual
12/08/2011
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Date of last participant enrolment
Anticipated
31/07/2013
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Actual
31/07/2013
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
230
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Dr GK Isbister
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Address [1]
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Calvary Mater Newcastle
Edith Street
Waratah 2298
NSW
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Dr G.K. Isbister
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Address
Calvary Mater Newcastle
Department of clinical pharmacology and toxicology
Edith Street
Waratah 2298
NSW
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Hunter New England
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Ethics committee address [1]
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Lambton Road New Lambton Heights 2305 NSW
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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20/05/2011
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Approval date [1]
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14/06/2011
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Ethics approval number [1]
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11/04/20/3.05
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Summary
Brief summary
Aggressive behaviour related to acute psychosis is an ever present problem in emergency admissions to psychiatric wards and intensive care units. It can lead to patient harm and prolonged distress, injury to staff and/or other patients and damage to hospital property if the situation is not rapidly controlled. Intramuscular sedation is commonly used to manage these patients when all other attempts including verbal de-escalation and oral sedation have failed. The most commonly used drugs for this purpose have been benzodiazepines and antipsychotics given by the intramuscular route, mainly midazolam and haloperidol. Intramuscular midazolam has proven to be unpredictable and can lead to both over-or under sedation of the acutely disturbed patient. It has a significant adverse effect profile due to over-sedation with respiratory depression and/or loss of airways patency. Conversely it is associated with under sedation when used to sedate patients with benzodiazepine tolerance. For this reason we no longer recommend the use of intramuscular midazolam for rapid sedation of acute behavioural disturbance in the emergency department. Haloperidol is also commonly used in this patient cohort but is associated with a high risk of extrapyramidal side effects and a risk of QT prolongation with associated Torsades de Pointes. Droperidol is less commonly used but is a highly sedative antipsychotic medication that is rarely associated with complications. This study aims to compare the effectiveness of droperidol compared to haloperidol for the sedation of aggressive patients with acute functional psychotic symptoms in a randomised controlled trial. The study is designed to assess both the speed of onset, effectiveness, and adverse effect profile of both agents. AIMS: This study aims to: 1. Compare the effectiveness of intramuscular droperidol to intramuscular haloperidol for sedation of aggressive patients with acute behavioural disturbance based on: a. the time until sedation occurs; b. the requirements for additional sedation. 2. Investigate the safety of intramuscular droperidol compared to haloperidol 3. Determine the practicality and effectiveness of introducing a sedation protocol into the psychiatric intensive care setting for patients with acute behavioural disturbance with related violent and aggressive symptoms; HYPOTHESES: The specific hypotheses of the study are that: 1. The time to sedation with intramuscular droperidol is shorter than intramuscular haloperidol; 2. Initial sedation with droperidol will require less additional sedation attempts compared to haloperidol; 3. Droperidol will result in a smaller proportion of extrapyramidal side-effects compared to haloperidol;
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Trial website
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Trial related presentations / publications
Not published as yet
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Geoffrey K Isbister
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Address
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Calvary Mater Newcastle
Edith Street Waratah
NSW 2298
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Country
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Australia
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Phone
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610249211312
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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A.Prof. G.K. Isbister
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Address
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Calvary Mater Newcastle
Edith Street
Waratah 2298
NSW
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Country
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Australia
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Phone
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+61 2 49 21 1627
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Fax
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+61 2 49 21 1870
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Email
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[email protected]
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Contact person for scientific queries
Name
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A.Prof. G.K. Isbister
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Address
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Calvary Mater Newcastle
Edith Street
Waratah 2298
NSW
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Country
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Australia
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Phone
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+61 2 49 21 1627
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Fax
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+61 2 49 21 1870
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Droperidol v. haloperidol for sedation of aggressive behaviour in acute mental health: Randomized controlled trial.
2015
https://dx.doi.org/10.1192/bjp.bp.114.150227
N.B. These documents automatically identified may not have been verified by the study sponsor.
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