Table 13.6GRADE Evidence summary: Cross review - typical antipsychotic vs atypical antipsychotic

Outcome/Author (year)Meta-analysis detailsSummary statisticsCommentsGRADE detailsGRADE Comments
Complete response
(Hu 2006: Skrobik 2004)
2 trials;
219 patients; from Meta analysis of RCTs
RR=0.00 (0.5%CI 0.8, 1.21% p=0.24; r2=27%No significant difference between haloperidol and olanzapine groups
  • Study quality: serious limitations not blinded
  • Directness: Indirect outcome - delirium assessment method
  • Imprecision: Number of events < 300
  • Inconsistency: consistant
  • Reporting bias: Adequate
Haloperidol vs olanzapine. One study [32.4% weight] inadequate sequence generation & allocation concealment, funding, and outcome possibly inadequate. Patients unblinded in major study and indirect outcome measure
GRADE evidence rating: Low
Duration of delirium
(Hu 2006)
1 trial;
148 patients; from RCT
MD=0.62 (0.5%CI 0.08, 1.18)Significantly shorter time to take effect for the olanzapine group compared to the haloperidol group
  • Study quality: Very serious limitations
  • Directness: Direct
  • Imprecision: Number of patients < 400
  • Inconsistency: consistent
  • Reporting bias: Adequate
Reported as time to take effect’ in responders only - likely to be biased
GRADE evidence rating: Very low
Severity of delirium
(Hu 2006)
1 trial;
148 patients; from RCT
MD=0.7 (0.5%CI −0.45, 1.85)No significant difference between the haloperidol and the olanzapine groups on the DRS (0=32)
  • Study quality: serious limitations not blinded
  • Directness: Direct
  • Imprecision: Number of patients < 400
  • Inconsistency: consistent
  • Reporting bias: Adequate
All patients received somatic treatment aiming at delirium; DRS scale 0–32, narrow CI, but fairly small trial. Patients not blinded.
GRADE evidence rating: Moderate
Adverse event (extrapyramidal)
(Skrobik 2004)
1 trial;
73 patients; from Quasi RCT
RR=8.2 (0.5%CI 0.48, 140.09)No significant difference Haloperidol vs olanzapine: Quasi randomised design; wide CI. Advance events carefully recorded; not blinded
GRADE evidence rating: Very low

From: 13, Treatment of delirium: pharmacological

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Delirium: Diagnosis, Prevention and Management [Internet].
NICE Clinical Guidelines, No. 103.
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