Oligoantiemesis or Inadequate Prescription of Antiemetics in the Emergency Department: A Local and National Perspective

Singer, Adam J.; Garra, Greg; Thode, Henry C.

doi:10.1016/j.jemermed.2016.03.019

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…Ever since the first ED‐based, placebo‐controlled antiemetic trial was published in 2006, there has been a consistent lack of support for the effectiveness of antiemetic drugs in the ED setting . In the past, a number of reasons have been proposed in the literature as to why the multiple study findings might be erroneous . The difficulty in accepting that antiemetic drugs may offer little for ED patients might stem from the decades of apparent support for their effectiveness in the postoperative and oncology settings.…”

Section: Discussionmentioning

confidence: 99%

“…ED‐based trials, however, have failed to demonstrate superiority for commonly used antiemetic drugs over placebo . Doubts have been expressed about these seemingly counterintuitive findings . Possible limitations of the currently used outcome measures for the detection of real differences and the difficulty of interpreting the main study results have been highlighted …”

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confidence: 99%

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Randomized Placebo‐controlled Trial of Droperidol and Ondansetron for Adult Emergency Department Patients With Nausea

Meek

Mee

Egerton‐Warburton

et al. 2018

Academic Emergency Medicine

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Objective: The objective was to separately compare effectiveness of 1.25 mg of intravenous (IV) droperidol and 8 mg of IV ondansetron with 0.9% saline placebo for adult emergency department (ED) patients with nausea. A novel primary outcome measure, expected to aid clinical interpretation of reported results, was employed.Methods: A randomized controlled trial was conducted at the three EDs of Monash Health, Melbourne, Australia. The design was to demonstrate superiority of the active drugs over placebo. The primary outcome measure of symptom improvement was defined as a visual analog scale (VAS) rating change of -8 mm or more from baseline at 30 minutes posttreatment. Mean VAS changes per group and percentages experiencing the desired treatment effect were also compared. The study was concluded after recruitment of 215 of the planned 378 patients, as interim analysis confirmed that continuation could not result in a finding of superiority.Results: Of 215 patients, 73 (34%), 71 (33%), and 71 (33%) received droperidol, ondansetron, and placebo.Symptom improvement occurred in 75% (95% confidence interval [CI] = 64% to 85%), 80% (95% CI = 69% to 89%), and 76% (95% CI = 64% to 85%), respectively. Mean VAS changes were -29 mm (95% CI = -36 to -23 mm), -34 mm (95% CI = -41 to -28 mm), and -24 mm (95% CI = -29 to -19 mm), respectively. Desired treatment effects were experienced by 77% (95% CI = 65% to 86%), 73% (95% CI = 61% to 83%), and 59% (95% CI = 47% to 71%), respectively. Conclusion:For adult ED patients with nausea, superiority was not demonstrated for droperidol or ondansetron over placebo.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Randomized Placebo‐controlled Trial of Droperidol and Ondansetron for Adult Emergency Department Patients With Nausea

Meek

Mee

Egerton‐Warburton

et al. 2018

Academic Emergency Medicine

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“…For many years, there was no reason to doubt the anecdotal impression that most ED patients’ nausea improved after they received drug treatment. The ED community has been surprised, however, by the findings of three ED‐based, placebo‐controlled antiemetic randomised controlled trials (RCTs) …”

Section: Background: ‘Proven’ Lack Of Benefit For Antiemetic Drugs Omentioning

confidence: 99%

Do antiemetic drugs benefit adult emergency department patients with nausea? The literature says no, but is it right?

Meek

Graudins

2017

Emerg Medicine Australasia

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Nausea is a common problem in ED patients. Antiemetic drugs have been used in the ED for decades, but a recent Cochrane review found no convincing evidence for the benefit of antiemetic drugs over placebo. This was largely based on three placebo-controlled trials, which found mean Visual Analog Scale (VAS) changes for various drugs and placebo, to be similar. However, reliance on mean VAS change as the primary outcome measure has probably been a mistake. It does not give information on the number of improved patients, so these cannot be compared between groups. Alternative primary outcome measures warrant further exploration. Use of a VAS cut-off level indicative of clinically significant symptom improvement would allow comparison of numbers of patients with improved nausea ratings. This is proposed as the best option currently available. Preliminary testing of this outcome measure suggests that the conclusions of past studies may be misleading, and that the question of antiemetic efficacy for ED patients is not yet answered.

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Customizing Your Antiemetic: What Should You Consider?

Murrett

Repanshek

Hinton

2019

Gastrointestinal Emergencies

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Oligoantiemesis or Inadequate Prescription of Antiemetics in the Emergency Department: A Local and National Perspective

Cited by 7 publications

References 13 publications

Randomized Placebo‐controlled Trial of Droperidol and Ondansetron for Adult Emergency Department Patients With Nausea

Randomized Placebo‐controlled Trial of Droperidol and Ondansetron for Adult Emergency Department Patients With Nausea

Do antiemetic drugs benefit adult emergency department patients with nausea? The literature says no, but is it right?

Customizing Your Antiemetic: What Should You Consider?

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