Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review

Bourke, Elyssia; Douglas, Ned; Wilson, Catherine L; Anderson, Damon Lindsay; Nehme, Ziad; Babl, Franz E

doi:10.1016/j.annemergmed.2023.04.028

Cited by 4 publications

(7 citation statements)

References 21 publications

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“…1.1% of pediatric behavioral EMS encounters in Florida 16 ; and 9% of pediatric behavioral EMS encounters in the Australian state of Victoria. 10 Pediatric restraint rates in the prehospital setting appear comparable to rates described among pediatric behavioral health patients in the ED (ranging from 2.4% to 6.5%), 23,24 despite limited staff in the prehospital setting who can engage in verbal deescalation and the lack of a secure environment such as a safe room. 7,29 We identified variation in physical restraint use by demographic characteristics.…”

Section: Discussionmentioning

confidence: 85%

“…We defined sedative medications as chlorpromazine, clonidine, diazepam, diphenhydramine, droperidol, haloperidol, ketamine, lorazepam, midazolam, olanzapine, quetiapine, risperidone, and ziprasidone. These medications have been described in the literature as treatment for acute agitation in children in the prehospital or ED setting 8,10,11 and/or are listed within state EMS protocols for pediatric behavioral health encounters (from Maryland, Utah, Rhode Island, and Michigan). 6 We examined demographic, clinical, and EMS-related characteristics, which were chosen based on prior literature suggesting relevance to behavioral health EMS encounters.…”

Section: Study Measuresmentioning

confidence: 99%

“…Our results are consistent with a study of pediatric behavioral health EMS encounters in Australia, which found that children with a history of autism spectrum disorder had 2.5 times higher adjusted odds of parental sedative medication use. 10 Children with autism spectrum disorder are more likely to visit the ED for a psychiatric condition than their peers, 35 highlighting a need to educate prehospital clinicians on working with children with neurodevelopmental disabilities, including autism spectrum disorder. 36 Also, specific interventions could be developed to prevent and reduce agitation in this population, such as personalized emergency information forms that delineate patient-specific triggers and deescalation techniques.…”

Section: -11 Years Old a Lack Of Comfort By Prehospital Clinicians In...mentioning

confidence: 99%

“…7 Patients can become acutely agitated during transport, requiring the use of verbal deescalation, sedative medications, and/or physical restraints to mitigate risks of patient or staff injury. [8][9][10] However, these interventions also carry their own risks. Adverse effects of sedative medications include dystonic reactions, respiratory depression, and arrythmias, 11 while physical restraint use can lead to psychological harm and physical injuries.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of pediatric behavioral health emergencies in the prehospital setting

Wnorowska,

Naik,

Ramgopal

et al. 2023

Academic Emergency Medicine

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ObjectiveApproximately 10% of emergency medical services (EMS) encounters in the United States are behavioral health‐related, but pediatric behavioral health EMS encounters have not been well characterized. We sought to describe demographic, clinical, and EMS‐system characteristics of pediatric behavioral health EMS encounters across the United States, and to evaluate factors associated with sedative medication administration and physical restraint use during these encounters.MethodsWe conducted a retrospective cross‐sectional study of pediatric (<18 years old) behavioral health EMS encounters from 2019‐2020 using the National Emergency Medical Services Information System. Behavioral health encounters were defined using primary or secondary impression codes. We used multivariable logistic regression to identify factors associated with sedative medication administration and physical restraint use.ResultsOf 2,740,271 pediatric EMS encounters, 309,442 (11.3%) were for behavioral health. Of pediatric behavioral health EMS encounters, 85.2% were 12‐17 years old, 57.3% were female, and 86.6% occurred in urban areas. Sedative medications and physical restraints were used in 2.2% and 3.0% of pediatric behavioral health EMS encounters, respectively. Sedative medication use was associated with the presence of developmental, communication, or physical disabilities relative to their absence (adjusted odds ratio [aOR] 3.38, 95% CI, 2.93, 3.91) and with encounters in the West relative to the South (aOR 1.23, 95% CI, 1.16, 1.32). Physical restraint use was associated with encounters by patients 6‐11 years old relative to 12‐17 years old (aOR 1.35, 95% CI 1.27, 1.44), the West relative to the South (aOR 3.49, 95% CI 3.27, 3.72), and private, nonhospital EMS systems relative to fire departments (aOR 3.39, 95% CI 3.18,3.61).ConclusionsAmong pediatric prehospital behavioral health EMS encounters, the use of sedative medications and physical restraint varies by demographic, clinical, and EMS‐system characteristics. Regional variation suggests opportunities may be available to standardize documentation and care practices during pediatric behavioral health EMS encounters.

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Section: Discussionmentioning

confidence: 85%

Section: Study Measuresmentioning

confidence: 99%

Section: -11 Years Old a Lack Of Comfort By Prehospital Clinicians In...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Characteristics of pediatric behavioral health emergencies in the prehospital setting

Wnorowska,

Naik,

Ramgopal

et al. 2023

Academic Emergency Medicine

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“… 9 , 10 , 18 An estimated 5.7% of all pediatric EMS transports in the state of Florida (USA) from 2011 through 2016 involved BHEs, 10 and a retrospective study of all EMS encounters that occurred in the city of Baltimore (Maryland USA) concluded that behavioral health problems were a significant cause of repeat use of EMS by patients < 21 years of age. 18 A recent study from Victoria, Australia also found that mental-health-related presentations accounted for 14% of all pediatric EMS encounters from July 2018 through June 2019, 19 so commonplace use of EMS for pediatric BHEs may not be unique to the United States. In addition to studies of EMS-specific data, it is estimated that one in four pediatric patients presenting to United States’ EDs with mental health needs arrive by ambulance, 4 and that 60% of adolescent psychiatrists report recommending to parents that they seek emergency services in the event of a behavioral health crisis.…”

Section: Discussionmentioning

confidence: 99%

EMS Responses for Pediatric Behavioral Health Emergencies in the United States: A 4-Year Descriptive Evaluation

Boland,

Anderson,

Powell

et al. 2023

Prehosp. Disaster med.

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Background:The occurrence of behavioral health emergencies (BHEs) in children is increasing in the United States, with patient presentations to Emergency Medical Services (EMS) behaving similarly. However, detailed evaluations of EMS encounters for pediatric BHEs at the national level have not been reported.Methods:This was a secondary analysis of a national convenience sample of EMS electronic patient care records (ePCRs) collected from January 1, 2018 through December 31, 2021. Inclusion criteria were all EMS activations documented as 9-1-1 responses involving patients < 18 years of age with a primary or secondary provider impression of a BHE. Patient demographics, incident characteristics, and clinical variables including administration of sedation medications, use of physical restraint, and transport status were examined overall and by calendar year.Results:A total of 1,079,406 pediatric EMS encounters were present in the dataset, of which 102,014 (9.5%) had behavioral health provider impressions. Just over one-half of BHEs occurred in females (56.2%), and 68.1% occurred in patients aged 14-17 years. Telecommunicators managing the 9-1-1 calls for these events reported non-BHE patient complaints in 34.7%. Patients were transported by EMS 68.9% of the time, while treatment and/or transport by EMS was refused in 12.5%. Prehospital clinicians administered sedation medications in 1.9% of encounters and applied physical restraints in 1.7%. Naloxone was administered for overdose rescue in 1.5% of encounters.Conclusion:Approximately one in ten pediatric EMS encounters occurring in the United States involve a BHE, and the majority of pediatric BHEs attended by EMS result in transport of the child. Use of sedation medications and physical restraints by prehospital clinicians in these events is rare. National EMS data from a variety of sources should continue to be examined to monitor trends in EMS encounters for BHEs in children.

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Emergency Department Pediatric Mental and Behavioral Health Patients Transported by Emergency Medical Services and Police: Trends and Interventions

Cheetham,

Babcock,

Hartwell

et al. 2024

Academic Pediatrics

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Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review

Cited by 4 publications

References 21 publications

Characteristics of pediatric behavioral health emergencies in the prehospital setting

Characteristics of pediatric behavioral health emergencies in the prehospital setting

EMS Responses for Pediatric Behavioral Health Emergencies in the United States: A 4-Year Descriptive Evaluation

Emergency Department Pediatric Mental and Behavioral Health Patients Transported by Emergency Medical Services and Police: Trends and Interventions

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