PHARMACOLOGICAL INTERVENTIONS FOR ACUTE BEHAVIOURAL DISTURBANCE (ABD) IN CHILDREN/ADOLESCENTS IN THE EMERGENCY DEPARTMENT (ED) A SYSTEMATIC REVIEW
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Keywords
Acute behavioural disturbance; Pediatric emergency department; Agitation; Pharmacological management; Antipsychotics; Benzodiazepines
Abstract
Acute behavioural disorder in children and adolescents is a common and problematic presentation in the emergency departments and in most cases, there is a need to intervene and provide safe care to the patients and staff. Pharmacological management is usually applied to de-escalation approaches that fail, but it is mostly based on observational data and fluctuating clinical practice.
Objective: To conduct a systematic review and synthesise the evidence to support the management of acute behavioural disturbance in children and adolescents presented to the emergency department under a pharmacological intervention.
Methods: The systematic review was followed in accordance with PRISMA. In PubMed/MEDLINE, Scopus, and Google Scholar, English-language studies published since January 2019 were searched and studied. Original human trials that assessed pharmacological treatments of acute behavioural disturbance in pediatric or adolescent emergency department were also considered. The extraction of the data was in a narrative format, and the quality of the methodology was evaluated with Joanna Briggs Institute critical appraisal tools.
Results: Eleven studies which satisfied inclusion criteria were observed. A majority of them were retrospective cohorts that were based in tertiary or high-volume emergency departments. The commonest used agents were antipsychotics and benzodiazepines and parenteral medications were mostly employed in severe agitation. Pharmacological therapy usually provided effective outcome with regard to the control of behaviour but repeat dosage and the concentrated use of restraints were common. Research that used standardized treatment algorithms had better results, with less restraint practices and a reduced emergency department length of stay. The overall risk of bias was moderate mainly because the study was confounded by indication and the outcome definitions were not consistent.
Conclusion: The management of acute behavioural disturbance in pediatric emergency care is based on pharmacological care although there is a paucity of high-quality evidence. This requires more standardisation of treatment procedures and outcome measures as well as prospective research to enhance safety, consistency, and effectiveness of care.
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Muhammad Salar Khan Daur
Higher Emergency Medicine Trainee, NIMDTA Craigavon Area Hospital, Craigavon, BT63 5QQ Northern Ireland. Email: [email protected]
Sana Zahid
BST trainee Psychiatry, RCSI, Republic of Ireland. Email: [email protected]
Consultant Liaison Psychiatry, Naas General Hospital, Naas, Co Kildare, W91 AE76, Republic of Ireland. Email: [email protected]
Arshad Aziz
BST trainee Psychiatry, RCSI, Republic of Ireland. Email: [email protected]
Consultant Liaison Psychiatry, Naas General Hospital, Naas, Co Kildare, W91 AE76, Republic of Ireland. Email: [email protected]
