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Pediatric Emergency Agitation Care Enhancement: Protocol for a Prospective Mixed Methods Study.

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This study evaluates the Brief Rating of Aggression by Children and Adolescents-Short Form (BRACHA-S) for predicting agitation in pediatric mental and behavioral health patients. Findings will inform a risk-based management plan to improve safety in emergency departments.

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Area of Science:

  • Pediatric Emergency Medicine
  • Child and Adolescent Psychiatry
  • Healthcare Safety and Quality Improvement

Background:

  • Agitation in pediatric mental and behavioral health (MBH) patients presenting to emergency departments (EDs) poses significant safety risks and strains resources.
  • A lack of validated tools for agitation risk stratification in this population hinders evidence-based management.
  • Developing effective strategies is crucial for reducing emergent interventions and enhancing patient and staff safety.

Purpose of the Study:

  • To evaluate the predictive accuracy of the Brief Rating of Aggression by Children and Adolescents-Short Form (BRACHA-S) for agitation requiring intervention in pediatric ED patients.
  • To codevelop a risk-based management plan bundle tailored for pediatric patients experiencing agitation or aggression in the ED.

Main Methods:

  • A prospective, single-center, mixed-methods study involving children and adolescents (aged 5-18) presenting to the ED with MBH concerns.
  • Nurses administered the BRACHA-S tool at triage; agitation requiring intervention was the primary outcome, defined by pharmacologic or physical/mechanical restraint use.
  • Qualitative methods, including interviews and workshops with patients, families, and staff, were used to codevelop a tiered, risk-based management plan.

Main Results:

  • Enrollment for Aim 1 (BRACHA-S validation) was completed with 472 participants; the study hypothesizes strong predictive validity (AUC >0.70).
  • Data collection for Aim 2 (management plan development) is ongoing, involving key informant interviews, group assessments, and participatory design workshops.
  • Anticipated results by June 2026 will include a stakeholder-informed, tiered management pathway aligned with BRACHA-S risk strata.

Conclusions:

  • This study proposes a pragmatic approach to early agitation risk identification and management in pediatric EDs.
  • Successful validation of BRACHA-S and implementation of a co-developed management pathway could significantly improve timely, least-restrictive interventions.
  • The findings aim to enhance patient and staff safety by addressing critical gaps in validated tools and structured workflows for agitated pediatric MBH patients.