Abstract
IntroductionAgitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff. We present consensus guidelines for management of agitation among pediatric patients in the ED, including non-pharmacologic methods and the use of immediate and as-needed medications.MethodsUsing the Delphi method of consensus, a workgroup comprised of 17 experts in emergency child and adolescent psychiatry and psychopharmacology from the the American Association for Emergency Psychiatry and the American Academy of Child and Adolescent Psychiatry Emergency Child Psychiatry Committee sought to create consensus guidelines for the management of acute agitation in children and adolescents in the ED.ResultsConsensus found that there should be a multimodal approach to managing agitation in the ED, and that etiology of agitation should drive choice of treatment. We describe general and specific recommendations for medication use.ConclusionThese guidelines describing child and adolescent psychiatry expert consensus for the management of agitation in the ED may be of use to pediatricians and emergency physicians who are without immediate access to psychiatry consultation.
Highlights
Agitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff
Using the Delphi method of consensus, a workgroup comprised of 17 experts in emergency child and adolescent psychiatry and psychopharmacology from the the American Association for Emergency Psychiatry and the American Academy of Child and Adolescent Psychiatry Emergency Child Psychiatry Committee sought to create consensus guidelines for the management of acute agitation in children and adolescents in the ED
These guidelines describing child and adolescent psychiatry expert consensus for the management of agitation in the ED may be of use to pediatricians and emergency physicians who are without immediate access to psychiatry consultation. [West J Emerg Med. 2019;20(2)409–418.]
Summary
Agitation in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, family and staff. We present consensus guidelines for management of agitation among pediatric patients in the ED, including non-pharmacologic methods and the use of immediate and as-needed medications. Agitation and aggression in children and adolescents in the emergency department (ED) can be dangerous and distressing for patients, families and staff.[1] Agitation and aggression can disrupt care, cause injury, or necessitate use of physical restraint. A survey of emergency physicians (EP) regarding pro re nata (as needed) (hereafter referred to as STAT/PRN) medications commonly used for agitation, and review papers providing recommendations for medication use, all emphasize use of first- and second-generation neuroleptics, benzodiazepines, and mood stabilizers.[2,6,7,8,9] These are largely inspired by consensus guidelines for treatment of agitated adults or pediatric outpatients with chronic aggression.[10,11,12] Symptoms and triggers that underlie agitation in the ED may be different from those that underlie chronic aggression among outpatients.[13]
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