Oral Medications for Treating Agitation in a Safety Net Emergency Department
Main findingResult — go to the resultDifference 24.2 percentage points 95% CI 23.6–24.8Authors' conclusion
In this quality improvement study, emergency physicians successfully adopted oral medications for treating agitation, primarily from intoxication. No difference was found in time to adequate sedation when oral or intramuscular medications were used as primary therapy.
Study context
- Population
- Emergency department (ED) patients in an urban level 1 adult and pediatric trauma center, January 1, 2018, to May 31, 2024; implementation cohort in an ED area for drug and alcohol intoxication
- Participants
- 460,600 ED encounters
- Exposure
- Postintervention vs preintervention period
- Before interventionn = 184,050reference
- After interventionn = 276,550
- Outcome
- Proportion of patients receiving their first sedating medication via the oral route
Methodological detailspre-post comparison, prospective observation during implementation, Implementation period September 16, 2020, to August 31, 2021
- Pre-post comparison
- Prospective observation during implementation
- Implementation period September 16, 2020, to August 31, 2021
Main finding
As reported in the abstract
Difference
24.2 percentage points
95% CI 23.6–24.8
By group
After intervention vs Before intervention
difference 24.2 percentage points (95% CI 23.6–24.8)
Observational data: associations, not effects.
Secondary outcomes
Any sedating medication
| Outcome | Median difference (minutes) (95% CI) | |
|---|---|---|
| Time to adequate sedation, oral vs intramuscular (implementation cohort) | 1 (−0.6 to 2.6) | |
| −2024Difference, minutes (linear scale) |
| Outcome | Difference (pp) (95% CI) | |
|---|---|---|
| Additional rescue medications, oral vs intramuscular | 3.4 (−2.0 to 8.8) | |
| −50510Difference, pp (linear scale) |
- Time to adequate sedation, oral vs intramuscular (implementation cohort): Oral median 15 (IQR 7–33) minutes
- Time to adequate sedation, oral vs intramuscular (implementation cohort): Intramuscular median 15 (IQR 9–26) minutes
- Additional rescue medications, oral vs intramuscular: Oral 31.8%
- Additional rescue medications, oral vs intramuscular: Intramuscular 28.4%
Any sedating medication
- Similar between time periods
Oral medication offered and accepted (implementation cohort, n=1178)
- Offered oral medication
- 630 (53.5%)
- Accepted, of those offered
- 446 (70.8%)
- Alcohol intoxication
- 860 [73.0%]
Safety
| Outcome | Oral | Intramuscular | Difference (pp) (95% CI) | |
|---|---|---|---|---|
| Adverse drug reactions, oral vs intramuscular | 2.7% | 1.1% | 1.6 (−0.1 to 3.3) | |
| −2024Difference, pp (linear scale) |
Original publication
Oral Medications for Treating Agitation in a Safety Net Emergency Department. JAMA Netw Open. Published 1 December 2025. doi:10.
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