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Pharmacologic Management of Agitation and Aggression in a Pediatric Emergency Department - A Retrospective Cohort
Insights
Benzodiazepines and antipsychotics are safe for managing pediatric agitation and aggression in emergency departments. Most children require a single dose with few adverse events, indicating good tolerability.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Neuroscience
Background:
- Limited data exists on benzodiazepine and antipsychotic use for acute agitation and aggression in pediatric emergency departments (EDs).
- Understanding medication patterns and safety is crucial for effective clinical management.
Purpose of the Study:
- To describe medication use for agitation and aggression in a pediatric ED.
- To assess the safety and tolerability of these medications in this population.
Main Methods:
- Retrospective observational study of patients under 20 years old presenting with agitation or aggression.
- Included patients received at least one dose of benzodiazepine or antipsychotic.
- Outcomes: medication frequency, dosing, and adverse events.
Main Results:
- Lorazepam (70%) and chlorpromazine (20%) were most common; 82% received a single dose.
- Intoxication correlated with multiple doses; autism/Asperger's associated with antipsychotic use (75% vs. 28%).
- Six adverse events occurred: oxygen desaturation (1), dizziness/nausea (2), dizziness (1), paradoxical excitation (2).
Conclusions:
- Benzodiazepine and antipsychotic therapy for acute pediatric agitation/aggression appears safe and well-tolerated.
- Single-agent use at recommended doses in the ED setting is supported by these findings.
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.
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