Rapid Tranquillisation: An AGREEable Ground?

Objective: Evidence base for rapid tranquillisation is an under researched area. Guidelines on rapid tranquilisation from English speaking countries were appraised using AGREE (Appraisal of Guidelines Research and Evaluation) and differences in their recommendations were analysed. Methods: Four independent psychiatrists appraised the guidelines using the AGREE tool. AGREE is a validated instrument used to assess the quality of guideline and recommendations using six domains of which each domain captures a specific aspect of the guideline development. The content was analysed manually. Results: Seven guidelines from five English speaking countries met the inclusion criteria. All the guidelines scored well on the domain of “scope and purpose”. NICE guidelines from the UK consistently scored well on all domains with the maximum possible score of 100 on the “applicability” domain. APA from the USA did well on the domain of “editorial independence”. AGREE could only examine the guideline development process and not the content. The guidelines differed in their recommendations of choice of drug for rapid tranquillisation. Discussion: All guidelines scored reasonably well on AGREE. National Institute of Clinical Excellence (NICE) has used robust strategies in developing the guidelines. Guidelines failed to achieve consensus in recommendations despite using a common pool of evidence. Haloperidol-promethazine combination is not recommended by any with the exception of NICE. This suggests data is selectively interpreted depending on locally prevalent customs. Corresponding author.