Haloperidol Use in Acute Traumatic Brain Injury: A Safety Analysis

Background: The association of delirium with poor outcomes creates a complex picture in traumatic brain injury patients by exacerbating an already increased risk for neurobehavioral sequelae. Haloperidol is commonly used for agitation and delirium; however, adverse events are concerns associated with its use in traumatic brain injury patients. The objective of this study was to assess the safety of haloperidol for the management of agitation and delirium in acute traumatic brain injury. Methods: A retrospective cohort study was conducted of adult ICU patients admitted from January 2007 to October 2009 with traumatic brain injury and admission Glasgow Coma Score ≤ 12. Incidence of complications (seizures, neuroleptic malignant syndrome, QTc prolongation, extrapyramidal symptoms, hematologic disturbances) and haloperidol prescribing patters were assessed. Results: A total of 101 patients were included (56 non-haloperidol, 45 haloperidol). There was no difference in types of brain injury. Haloperidol was initiated on average day 8 of admission, and the median daily dose was 9 mg for a median duration of 4 days. The haloperidol group received more analgesics (morphine equivalents) [714 vs. 252 mg, p < 0.001], and more patients in the haloperidol group received benzodiazepines compared to non-haloperidol group [98% vs. 79%, p = 0.005]. There was no significant increase in adverse events associated with haloperidol use. Patients in the haloperidol group who developed complications received a higher mean daily dose [p = 0.013]. There was no difference in length of mechanical ventilation but the haloperidol group had a longer hospital length of stay. Conclusion: Treatment of agitation and delirium with haloperidol in acute traumatic brain injury patients is not associated with an increased incidence of complications.