Adherence with an Acute Agitation Algorithm and Subsequent Restraint Use

Area of Science:

• Pediatric Emergency Medicine
• Pharmacology
• Patient Safety

Background:

• Acute agitation in pediatric patients often necessitates interventions like physical restraints.
• Pharmacological interventions are increasingly used to manage acute agitation.
• Standardized treatment protocols aim to optimize care and reduce adverse events.

Purpose of the Study:

• To evaluate if adherence to standardized pharmacological recommendations decreases physical restraint use in acutely agitated pediatric patients.
• To identify predictors of physical restraint use.
• To describe adverse events associated with pharmacological treatment.

Main Methods:

• Retrospective chart review of pediatric emergency department visits from September 1, 2016, to August 31, 2017.
• Inclusion criteria: pediatric patients treated for acute agitation with pharmacologic management or physical restraint.
• Comparison of physical restraint rates between patients treated per recommendations and those not.

Main Results:

• No significant difference in physical restraint use was observed between adherence to and non-adherence to standardized recommendations (P=0.16).
• Presentation during day shift, compared to evening shift, increased the odds of physical restraint use (OR 2.03; 95% CI 1.18, 3.50).
• Nine adverse events possibly related to medications were reported, none of significant clinical concern.

Conclusions:

• Standardized pharmacological treatment recommendations were not associated with a decrease in physical restraint use for agitated pediatric patients.
• Pharmacological strategies were generally safe and well-tolerated in this population.
• Further research may be needed to identify effective strategies for reducing physical restraint use in pediatric agitation.