Pharmacologic Management of Agitation and Aggression in a Pediatric Emergency Department – A Retrospective Cohort Study

Abstract

BACKGROUND Benzodiazepine and antipsychotic use for acute management of agitation and aggression in the pediatric emergency department (ED) setting has not been well described. OBJECTIVES To describe medication utilization in the management of agitation and aggression in a pediatric ED and to assess the safety of their use. METHODS This was a retrospective observational study. Patients less than 20 years of age who presented to our pediatric ED and had agitation or aggression as part of their chief complaint were included if they received at least 1 dose of benzodiazepine or antipsychotic. Outcomes included frequency of benzodiazepine and antipsychotic use, dosing of medications, and reported adverse events. RESULTS During the 5-year study period, there were 128 visits of 120 patients who met the inclusion criteria. Lorazepam was most commonly given (70%), followed by chlorpromazine (20%). Most patients (82%) required a single dose of medication. Intoxication was associated with needing more than 1 dose of medication. Patients with autism or Asperger syndrome were more likely to receive an antipsychotic medication compared to not having these conditions (75% vs. 28%, respectively). Adverse events were documented in 6 visits: oxygen desaturation (n = 1), dizziness and nausea (n = 2), dizziness (n = 1), and paradoxical excitation (n = 2). The Naranjo Score indicated a probable adverse drug reaction for the cases of paradoxical excitation. CONCLUSIONS Benzodiazepine and antipsychotic drug therapy for acute agitation and aggression in children appears to be safe and well tolerated when used as a single agent and at the recommended doses in this setting.

First line in psychiatric emergency: Pre-hospital emergency protocol for mental disorders in Iran

“…Lorazepam can be a useful drug, given the short time in the pre-hospital emergency and the need to calm the patient down with the least side effect. Lorazepam can be used in mild to moderate emergencies and in patients who are more cooperative (33).…”

First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran

“…Lorazepam can be a useful drug, given the short time in the pre-hospital emergency and the need to calm the patient down with the least side effect. Lorazepam can be used in mild to moderate emergencies and in patients who are more cooperative [34].…”

Evaluation of Psychotropic Drug Use in Adolescents Accessing a General Emergency Medical Department for Mental Disorders

“…According to the available data, effective and safe management of agitation includes both non-pharmacological and pharmacological strategies [15,[22][23][24].…”

“…Nevertheless, the use of benzodiazepines (lorazepam) or antipsychotics (haloperidol, olanzapine, risperidone, and ziprasidone) for the rapid tranquilization of children and adolescents with agitation is widely recommended [15,[22][23][24].…”

“…The pattern of psychotropic drug prescription in outpatient children and adolescents is largely described [13], but little is known concerning therapies administered or prescribed in the ED setting [14,15]. This finding does not reflect the increased use of emergency care services for acute episodes of mental disorders, in particular for anxiety and depressive symptoms [11,12], while the ED physicians may be required to establish the first therapeutic interventions.…”