Strategies for optimal management of pediatric acute agitation in emergency settings

Mohsen Saidinejad, David Geffen School of Medicine at UCLA The Lundquist Institute for Biomedical Innovation at Harbor UCLA Department of Emergency Medicine, Harbor UCLA Medical Center Torrance California USA.
Ashley A. Foster, Department of Emergency Medicine Benioff Children's Hospital University of California San Francisco California USA.
Genevieve Santillanes, Department of Pediatrics Los Angeles General Medical Center Keck School of Medicine of University of Southern California Los Angeles California USA.
Joyce Li, Department of Pediatrics Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA.
Dina Wallin, Department of Emergency Medicine Benioff Children's Hospital University of California San Francisco California USA.
Isabel A. Barata, Departments of Emergency Medicine and Pediatrics Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Manhasset New York USA.
Madeline Joseph, Department of Emergency Medicine University of Florida, College of Medicine Jacksonville Florida USA.
Emily Rose, Department of Emergency Medicine Los Angeles General Medical Center Keck School of Medicine of University of Southern California Los Angeles California USA.
Tabitha Cheng, David Geffen School of Medicine at UCLA The Lundquist Institute for Biomedical Innovation at Harbor UCLA Department of Emergency Medicine, Harbor UCLA Medical Center Torrance California USA.
Muhammad Waseem, Department of Pediatrics Lincoln Medical Center Bronx New York USA.
Kathleen Berg, Department of Pediatrics University of Texas at Austin-Dell Medical School Austin Texas USA.
Gwendolyn Hooley, Department of Emergency Medicine Children's Hospital, Keck School of Medicine at University of Southern California Los Angeles California USA.
Timothy Ruttan, Department of Pediatrics University of Texas at Austin-Dell Medical School Austin Texas USA.
Sam Shahid, American College of Emergency Physicians Irving Texas USA.
Samuel H. Lam, Department of Pediatrics Children's Hospital Colorado University of Colorado School of Medicine Aurora Colorado USA.
Siraj Amanullah, Department of Emergency Medicine Brown University School of Medicine Providence Rhode Island USA.
Sophia Lin, Department of Emergency Medicine Weill Cornell Medicine New York New York USA.
Melanie S. Heniff, Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA.
Kathleen Brown, Department of Pediatrics George Washington University School of Medicine Washington District of Columbia USA.
Marianne Gausche-Hill, David Geffen School of Medicine at UCLA The Lundquist Institute for Biomedical Innovation at Harbor UCLA Department of Emergency Medicine, Harbor UCLA Medical Center Torrance California USA.

Document Type

Journal Article

Publication Date

8-1-2024

Journal

Journal of the American College of Emergency Physicians open

Volume

5

Issue

4

DOI

10.1002/emp2.13255

Keywords

agitation; environmental modification; least restrictive means; neurodivergent; restraint use; verbal de‐escalation

Abstract

Acute agitation in youth is a challenging presentation to the emergency department. In many cases, however, youth can be behaviorally de-escalated using a combination of environmental modification and verbal de-escalation. In cases where additional strategies such as pharmacologic de-escalation or physical restraint are needed, using the least restrictive means possible, including the youth in the decision-making process, and providing options are important. This paper reviews specific considerations on the approach to a youth with acute agitation and strategies and techniques to successfully de-escalate agitated youth who pose a danger to themselves and/or others.

Department

Pediatrics

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