Agitation: A Clinical Review for Emergency Physicians

Agitation is a common clinical presentation associated with up to 2.6% of emergency department (ED) visits per year. The science of identifying, predicting, and managing agitation has rapidly progressed over the past decade, leading to broad recommendations about initial approaches and management strategies.

The purpose of this clinical review is to review existing literature on the etiology, recognition, and management of agitation to help clinicians and staff who care for these patients.

A narrative review was performed of articles published from 1984 to 2026.

Standardized approaches to agitation management are discussed, highlighting both existing literature and research gaps. There is broad agreement on 5 main objectives of the approach to the agitated patient in the ED: address safety issues for the patient and ED staff, an expedited clinical assessment, identifying a presumptive etiology of agitation in order to guide treatment, verbal de-escalation as an initial management strategy, and judicious medication administration.

This review shows that practices like verbal de-escalation, therapeutically-indicated medication administration, and multidisciplinary teamwork are imperative to improving care and reducing mistrust, longer hospital stays, use of restraints, and physical assaults on ED staff and ultimately, workplace violence. In particular, verbal de-escalation should be a first-line treatment. There is agreement that the etiology of agitation should guide management, but less agreement on particular drug combinations if medication is needed. Recommendations are given but further research is necessary.