Intramuscular droperidol versus intramuscular dimenhydrinate for the treatment of
acute peripheral vertigo in the emergency department: a randomized clinical
trial.
Author(s): Irving C, Richman P, Kaiafas C, Eskin B, Allegra J.
Affiliation(s): Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, NJ
07960, USA. cirvingmd@aol.com
Publication date & source: 2002, Acad Emerg Med. , 9(6):650-3
OBJECTIVE: The emergency department (ED) treatment of acute peripheral vertigo
(APV) has not been well studied. The purpose of this study was to determine the
efficacy of intramuscular (IM) droperidol vs IM dimenhydrinate, in the treatment
of ED patients with APV.
METHODS: The study was a randomized, double-blinded clinical trial, performed at
a suburban, teaching ED. A convenience sample of adult patients with symptoms and
signs consistent with rigid diagnostic criteria for APV were randomized to one of
two treatment groups. Patients more than 65 years of age were excluded to reduce
the likelihood of diagnostic misclassification. Demographic and historical
features were recorded on a standardized data form. Patients recorded their
initial level (t0) of discomfort on a 10-centimeter (cm) visual analog scale
(VAS). Treatment group 1 received 2.5 mg droperidol IM, while treatment group 2
received 50 mg dimenhydrinate IM. After 30 minutes (t30), patients again recorded
the severity of their symptoms on the VAS. Chi-square, t-tests, and Mann-Whitney
were used for statistical comparison as appropriate. All tests were two-tailed,
with alpha set at 0.05. Primary outcome parameters were the mean change in VAS
score from t0 to t30, and the percentage of patients in each treatment group who
felt well enough to go home after t30 without further ED intervention.
RESULTS: There were 20 patients in the droperidol group and 20 in the
dimenhydrinate group. The two groups were similar with respect to mean age (40
+/- 13 years droperidol vs. 42 +/- 13 years dimenhydrinate; p = 0.6), female sex
(60% vs. 50%; p = 0.7), and mean median duration of symptoms [3 (interquartile
range 2-12) vs 9 (interquartile range 2-30) hours; p = 0.2]. Mean initial t0 VAS
scores were 7.2 +/- 2.3 and 7.8 +/- 1.9 (p = 0.47). Both treatment groups had
mean reductions in VAS scores at t30 of 3.3 [95% confidence interval (95% CI) =
2.3 to 4.3]. At t30, 42% of patients in the droperidol group and 45% of patients
in the dimenhydrinate group felt well enough to go home without further ED
intervention.
CONCLUSIONS: The authors found no difference between the therapeutic efficacies
of IM droperidol and dimenhydrinate for the treatment of acute peripheral
vertigo.
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