TITLE:
Rapid Tranquillisation: An AGREEable Ground?
AUTHORS:
Pallavi Nadkarni, Mahesh Jayaram, Shailesh Nadkarni, Ranga Rattehalli, Clive Adams
KEYWORDS:
Tranquillisation, Guidelines, Anti-Psychotics, Psychiatric Emergencies
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.3,
July
24,
2014
ABSTRACT: Objective:
Evidence base for rapid tranquillisation is an under researched area. Guidelines
on rapid tranquilisation from English speaking countries were appraised using
AGREE (Appraisal of Guidelines Research and Evaluation) and differences in
their recommendations were analysed. Methods: Four independent psychiatrists
appraised the guidelines using the AGREE tool. AGREE is a validated instrument
used to assess the quality of guideline and recommendations using six domains
of which each domain captures a specific aspect of the guideline development.
The content was analysed manually. Results: Seven guidelines from five English
speaking countries met the inclusion criteria. All the guidelines scored well
on the domain of “scope and purpose”. NICE guidelines from the UK consistently
scored well on all domains with the maximum possible score of 100 on the “applicability”
domain. APA from the USA did well on the domain of “editorial independence”.
AGREE could only examine the guideline development process and not the content.
The guidelines differed in their recommendations of choice of drug for rapid
tranquillisation. Discussion: All guidelines scored reasonably well on AGREE.
National Institute of Clinical Excellence (NICE) has used robust strategies in
developing the guidelines. Guidelines failed to achieve consensus in
recommendations despite using a common pool of evidence. Haloperidol-promethazine
combination is not recommended by any with the exception of NICE. This suggests
data is selectively interpreted depending on locally prevalent customs.