A Retrospective Review of Antipsychotic Medications Administered to Psychiatric Patients in a Tertiary Care Pediatric Emergency Department

Rudolf, Frances; Hollenbach, Kathryn A.; Carstairs, Keri L.; Carstairs, Shaun D.

doi:10.5863/1551-6776-24.3.234

Cited by 5 publications

(10 citation statements)

References 6 publications

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“…The literature on the use of psychiatric medications with children and youth in ED settings is quite sparse. Rudolf et al ( 2019 ) identified 224 youth who received antipsychotic medications in the pediatric ED of a tertiary care hospital between 2009 and 2016. Chief complaints were suicidal ideation (47.6%), aggression (28.0%), homicidal ideation (10.5%), hallucinations (7.4%), and agitation (6.1%).…”

Section: Categories Of Informationmentioning

confidence: 99%

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Hoge

Vanderploeg

Paris

et al. 2022

Community Ment Health J

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There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

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Section: Categories Of Informationmentioning

confidence: 99%

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Hoge

Vanderploeg

Paris

et al. 2022

Community Ment Health J

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“…Similarly, Rudolf et al reported a comparable atypical antipsychotic use (olanzapine, 51.1%; aripiprazole, 26.6%) among PED psychiatric patients. 27 Predictors of acute agitation reported in prior studies include a history of disruptive behavior, autism spectrum disorder and intellectual disability, ADHD, psychosis, substance intoxication or withdrawal, and disruptive, impulse control, and conduct disorders. 4,19,32,34 Independent predictors of agitation and restraint use observed in this study were consistent with the observed predictors in prior studies.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in keeping with prior reports, our study establishes that restraint use was independently associated with longer ED LOS and higher admission rates. 27,32 Prior studies have suggested that restraint use may be an indicator of more severe disease state, leading to higher admission rates. 32 In conclusion, acute agitation remains a relatively common behavioral health emergency seen in the ED.…”

Section: Discussionmentioning

confidence: 99%

“… 18 , 19 However, in contrast to our study, Rudolf et al reported a much higher proportion of patients presenting with a complaint of agitation (28.0%) among 229 patients who received antipsychotic medications. 27 In addition to sample‐size limitation, the inclusion criteria of this study potentially introduced significant selections bias, with a likely overestimation of the prevalence of agitation.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Rudolf et al reported a comparable atypical antipsychotic use (olanzapine, 51.1%; aripiprazole, 26.6%) among PED psychiatric patients. 27 …”

Section: Discussionmentioning

confidence: 99%

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The agitated pediatric patient located in the emergency department: The APPLIED observational study

et al. 2022

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Objectives Focused research on pediatric agitation is lacking despite being a common mental and behavioral health (MBH) emergency. Prevalence of pediatric agitation remains unknown, and prior reports may have underestimated the rate of restraint use for pediatric agitation. This is the largest study to provide a focused evaluation of the prevalence and predictors of pediatric agitation and restraint use as well as the emergency department (ED) length of stay (LOS) and admission rates for agitated patients. Methods We reviewed records of patients aged ≤18 years with MBH needs who visited the pediatric ED of a tertiary care hospital during a 3‐year‐period. We identified and ascertained agitated/aggressive patients using documented signs/symptoms, International Classification of Diseases, Tenth Revision codes, and Behavioral Activity Rating Scale scores. We performed descriptive and multivariable analyses using SAS 9.4 (SAS Institute). Results Of 10,172 patients with MBH needs, 1408 (13.8%) were agitated/aggressive. Of these (n = 1408), 63.7% were boys, and the mean age was 11.9 years. Among agitated patients, the prevalence of restraint use was 28.7%, with a predominance of pharmacologic restraint with atypical antipsychotics. Non‐Hispanic Blacks were more likely to be agitated (adjusted odd ratio [aOR], 1.8; 95% CI, 1.2–2.7), but not restrained (aOR, 0.8; 95% CI, 0.3–1.8). Predictors of restraint use include history of attention deficit hyperactivity disorder (aOR, 2.2; 95% CI, 1.5–3.3), autism (aOR, 2.9; 95% CI, 1.9–4.5), conduct disorder (aOR, 1.7; 95% CI, 1.2–2.5), psychosis (aOR, 14.3; 95% CI, 2.5–271.8), and substance use/overdose states (aOR, 1.9; CI, 1.2–3.2). Restrained agitated patients had longer ED LOS (8.4 vs 5.0 hours; P < 0.0001) and higher admission rates (aOR, 2.6; 95% CI, 2.0–3.5). Depression (aOR, 0.4; 95% CI, 0.3–0.5) and suicidality (aOR, 0.2; 95% CI, 0.1–0.3) were protective against agitation and restraint use. Conclusion Prevalence of acute agitation and restraint use in pediatric EDs may be much higher than previously reported. Predictors of acute agitation and restraint use among MBH patients were consistent with prior reports. Restrained agitated patients had longer ED LOS and higher admission rates.

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Children and Adolescents

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Approximately 15% of young people experience depression by age 18 and these young people often have significant functional impairment and risk of harm. Bipolar depression is a common clinical challenge and its treatment has been studied much less in youth compared than in adults. Schizophrenia is rare in children but the incidence increases rapidly in adolescence. Algorithms for treating psychosis in children and adolescents are the same as those for adult patients. Anxiety symptoms in children and adolescents often improve with age, presumably in parallel to the development of the prefrontal cortex and, in particular, executive function. Treatment of anxiety disorders in pre‐school children must routinely focus on psychotherapy. The treatment of obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) in children and adolescents follows the same principles as in adults. Discontinuing medication is very typically associated with a deterioration in symptoms of OCD or BDD.

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A Retrospective Review of Antipsychotic Medications Administered to Psychiatric Patients in a Tertiary Care Pediatric Emergency Department

Cited by 5 publications

References 6 publications

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

The agitated pediatric patient located in the emergency department: The APPLIED observational study

Children and Adolescents

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