Quetiapine Versus Haloperidol for the Treatment of Delirium in Hospitalized Adults: A Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis.

OBJECTIVE

To evaluate the comparative efficacy and safety of quetiapine versus haloperidol for delirium treatment in hospitalized adults.

DATA SOURCES: Systematic search in MEDLINE (via PubMed), Embase, and Cochrane Central Register of Controlled Trials from inception through February 19, 2026.

STUDY SELECTION: RCTs directly comparing quetiapine and haloperidol for delirium treatment in adult inpatients.

DATA EXTRACTION: Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 2 tool. Primary outcome was change in delirium severity (DRS-R-98). Secondary outcomes included ICU and hospital length of stay (LOS), mortality, sleep duration, and extrapyramidal symptoms (EPS).

DATA SYNTHESIS: Four RCTs comprising 292 patients were included. No significant difference was found in delirium severity reduction (MD, -1.99; 95% CI, -4.70 to 0.72; p = 0.15; I2 = 73.6%), ICU LOS (MD, -0.84 days; 95% CI, -2.30 to 0.62), hospital LOS (MD, -0.06 days; 95% CI, -2.32 to 2.19), or mortality (RR, 0.68; 95% CI, 0.35 to 1.34). Quetiapine showed non-significant trends toward fewer EPS (RR, 0.14; 95% CI, 0.02 to 1.06) and increased sleep duration (MD, 1.59 h; 95% CI, -0.45 to 3.63). TSA indicated the required information size was not reached.

CONCLUSIONS

Quetiapine and haloperidol show no statistically significant differences in efficacy or safety for delirium management. GRADE certainty was very low for all outcomes, and TSA confirmed the evidence is inconclusive due to sparse data and imprecision. The absence of statistical significance should not be interpreted as equivalence. Selection should be individualized based on individual patient risk profiles and adverse-effect susceptibility until adequately powered trials are available.