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Objectives: A multicenter randomized clinical trial in Hong Kong Accident and Emergency (A&E) departments concluded that intramuscular (IM) olanzapine is noninferior to haloperidol and midazolam, in terms of efficacy and safety, for the management of acutely agitated patients in A&E setting. Determining their comparative cost-effectiveness will further provide an economic perspective to inform the choice of sedative in this setting.Methods: This analysis used data from a randomized clinical trial conducted in Hong Kong A&E departments between December 2014 and September 2019. A within-trial cost-effectiveness analysis comparing the 3 sedatives was conducted, from the A&E perspective and a within-trial time horizon, using a decision-analytic model. Sensitivity analyses were also undertaken.Results: In the base-case analysis, median total management costs associated with IM midazolam, haloperidol, and olanzapine were Hong Kong dollar (HKD) 1958.9 (US dollar [USD] 251.1), HKD 2504.5 (USD 321.1), and HKD 2467.6 (USD 316.4), respectively. Agitation management labor cost was the main cost driver, whereas drug costs contributed the least. Midazolam dominated over haloperidol and olanzapine. Probabilistic sensitivity analyses supported that midazolam remains dominant > 95% of the time and revealed no clear difference in the cost-effectiveness of IM olanzapine versus haloperidol (incremental cost-effectiveness ratio 667.16; 95% confidence interval -770.89, 685.90).Conclusions: IM midazolam is the dominant cost-effective treatment for the management of acute agitation in the A&E setting. IM olanzapine could be considered as an alternative to IM haloperidol given that there is no clear difference in cost-effectiveness, and their adverse effect profile should be considered when choosing between them. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims The aim of the study was to develop a simplified emergency trauma score ( SETS) for rating injury severity as well as triaging and predicting mortality in Hong Kong. Background Many existing trauma scoring systems require measurements that are not generally available in emergency settings in Hong Kong. As many of these important measures in the scoring systems are not available before the patients are admitted in the hospitals, it may delay treatment because of the extent of a patient's injury is often not clear at the site of accident or in the emergency settings. Design A retrospective cohort analysis of trauma patients' records from Trauma Registry in Hong Kong was performed. Method Potential significant parameters in predicting mortality were identified by univariate analysis. Binary logistic regression then was used to develop an equation for SETS. Four parameters including age, Glasgow coma scale, respiratory rate and American College of Surgeons ( ACS) mechanism of injury were identified, and the reliability and validity of SETS was assessed. Results At cut-off point of a SETS score of 60, the sensitivity and specificity of SETS were 64% and 98% respectively. The area under receiver operating characteristic curve was 0·939 which was comparable with other commonly used trauma scores. Conclusions SETS should be considered a relevant trauma scoring system in Hong Kong emergency settings. It is suggested that similar scoring systems should be developed in other countries based upon obtainable measures in their corresponding emergency settings. Relevance to clinical practice As a trauma scoring system is closely related to the context of its application, a system that can facilitate accurate sorting of patients into treatment hierarchies should be adopted in the congested emergency settings. [ABSTRACT FROM AUTHOR]