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Predicting Agitation in the Emergency Department.
Bijan Ketabchi1, Lynn Babcock2, Yin Zhang3
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
The Brief Rating of Aggression by Children and Adolescents (BRACHA) and its shortened version (BRACHA-S) accurately predict agitation requiring intervention in youth presenting to the emergency department (ED). These tools enable early risk stratification for improved patient safety.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Health Services Research
Background:
- Emergency departments (EDs) frequently encounter youth with mental and behavioral health (MBH) concerns.
- Agitation requiring intervention poses risks to patients and staff and complicates ED workflow.
- Early identification of youth at risk for agitation is crucial for timely intervention and resource allocation.
Purpose of the Study:
- To evaluate the Brief Rating of Aggression by Children and Adolescents (BRACHA) and its components in predicting agitation requiring intervention among youth in the ED.
- To develop and validate a tool for early risk stratification of agitated youth in the ED setting.
- To inform the development of targeted interventions and resource management strategies.
Main Methods:
- A retrospective cohort study of 32,906 ED MBH encounters involving patients aged 5-18 years (2012-2020).
- Inclusion criteria required a completed BRACHA assessment.
- Agitation requiring intervention was the primary outcome, with predictive accuracy measured by Area Under the Receiver Operator Characteristic Curve (AUROC).
- A shortened version, BRACHA-S, was developed using regression analysis and risk-stratified tiers were created.
Main Results:
- 10.7% of ED MBH encounters resulted in agitation requiring intervention.
- The BRACHA demonstrated strong predictive accuracy with an AUROC of 0.81 (95% CI 0.79-0.82).
- The BRACHA-S achieved an AUROC of 0.80 (95% CI 0.78-0.81).
- Risk ratios for agitation requiring intervention were 6.0 for moderate-risk and 14.0 for high-risk BRACHA-S tiers compared to low-risk.
Conclusions:
- Both the BRACHA and BRACHA-S are effective tools for predicting agitation requiring intervention in pediatric ED settings.
- These validated tools support accurate risk stratification, enabling proactive management strategies.
- Implementation of BRACHA and BRACHA-S can enhance patient safety and optimize resource allocation in emergency care for youth with MBH concerns.
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