Haloperidol Versus Atypical Antipsychotics for Delirium in Hospitalized and ICU Patients: A Systematic Review and...

While there is still debate over the benefit of antipsychotics in delirium management, surveys indicate their frequent use in clinical practice. Previous systematic reviews and meta-analyses have focused on assessing the effectiveness of antipsychotics versus placebo in delirium management. However, despite increasing access to atypical antipsychotics in hospital settings, robust analyses of studies comparing the effectiveness of haloperidol and atypical antipsychotics are lacking.

To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the effectiveness and safety of haloperidol versus atypical antipsychotics in the management of delirium patients.

We conducted a systematic search of Medline, Scopus, and Cochrane for RCTs comparing atypical antipsychotics with haloperidol in delirium patients. Odds ratio (OR) was used to analyze dichotomous variables. Continuous outcomes were compared using mean difference (MD) and standardized mean difference (SMD). The random effects model was applied to all endpoints.

Eleven RCTs (n=1450 patients) met the eligibility criteria. Delirium severity (SMD, -0.03; [95% CI, -0.20 to 0.15]; P = 0.78) and overall mortality (OR, 1.26; [95% CI, 0.88-1.80]; P = 0.20) did not differ significantly between groups. However, patients treated with haloperidol had significantly higher odds of experiencing extrapyramidal symptoms compared with those treated with atypical antipsychotics (OR, 2.72; [95% CI, 1.26-5.87]; P = 0.01).

While there were no significant differences in the effectiveness between treatments, patients treated with haloperidol had nearly a 3-fold increase in the incidence of extrapyramidal symptoms, indicating a potential advantage of atypical antipsychotics in minimizing adverse effects.