Wednesday, September 27, 2017

Quick take: delirium + clinical trials

My hat’s off to Drew Rosielle for his recent post about delirium at Pallimed, and for this passage in particular:

“...delirium is an international health crisis, it is real, it can be devastating (lead to permanent cognitive changes), leads to far worse outcomes for our patients (longer hospital stays, not being discharged home), costs billions of dollars, sucks shit for the patients and families going through it, and we don’t have a real inkling about actual, effective drug treatment for it.”


Rosielle’s focus is the report in JAMA on a study conducted at MD Anderson Cancer Center that compared haloperidol + lorazepam versus haloperidol + placebo as treatment for hyperactive (agitated) delirium at end of life. It’s a worthwhile read, and one that I’ll return to in a later post.

His overall concern is the lack of firm guidance for the treatment of delirium with drugs based on double-blind randomized clinical trials (RCT), the gold-standard for evidence-based practice. So, here’s a brief discussion about clinical trials, and about another less-rigorous way that we can know our actions are based on something more than crazy ideas shared around a late-night campfire.