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. 2023 Apr;35(2):254-260.
doi: 10.1111/1742-6723.14105. Epub 2022 Nov 3.

Management of paediatric acute severe behavioural disturbance in emergency departments across Australia: A PREDICT survey of senior medical staff

Elyssia M Bourke  1   2   3 , Jonathan C Knott  2   4 , Simon Craig  1   5   6 , Franz E Babl  1   2   7   8 ; Paediatric Research in Emergency Departments International Collaborative (PREDICT) Research Network
Collaborators, Affiliations

Management of paediatric acute severe behavioural disturbance in emergency departments across Australia: A PREDICT survey of senior medical staff

Elyssia M Bourke et al. Emerg Med Australas. 2023 Apr.

Abstract

Objective: Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in EDs. It poses a significant risk to the patient and those around them. Little is known about the epidemiology or most effective management in the paediatric population. The aim of the present study is to clarify the practice of senior emergency doctors in Australia when managing paediatric ASBD.

Methods: The present study was a voluntary electronic questionnaire distributed to and undertaken by senior medical staff in EDs affiliated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network. Respondents reported on exposure to and confidence in managing paediatric ASBD and their current practices.

Results: A total of 227 (33%) clinicians completed the survey between February and May 2020. Most clinicians were caring for at least two young people with ASBD each week (72%), felt confident regarding the majority of components of management and referred to local clinical practice guidelines (69%). Agitation/sedation rating scales were seldom used (19%). There was a significant variation in self-reported management practices. The choice of whether to use medication at all, the medication chosen and route of administration all varied greatly. Respondents were more willing to provide parenteral medication to young people reported as having recreational drug intoxication (84%) than those with neurodevelopment disorders (65%) when the same degree of agitation was reported.

Conclusions: Within Australia, there is considerable variation in paediatric ASBD practice, in particular regarding medication provision. Further prospective research is required to inform best clinical practice.

Keywords: child psychiatry; hypnotic and sedative; paediatric emergency medicine; psychomotor agitation.

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Conflict of interest statement

FEB and SC are section editors for Emergency Medicine Australasia and were excluded from the peer‐review process and all editorial decisions related to the acceptance and publication of this article. Peer‐review was handled independently by members of the editorial board to minimise bias.

Figures

Figure 1
Figure 1
Number of children and adolescents with acute severe behavioural disturbance each clinician reported they were caring for in an average week. (formula image), Paediatric EDs; (formula image), mixed EDs; (formula image), overall.
Figure 2
Figure 2
Clinician confidence in managing paediatric acute severe behavioural disturbance.
Figure 3
Figure 3
Medication dosing timeframes in paediatric acute severe behavioural disturbance. (formula image), Paediatric EDs; (formula image), mixed EDs.
Figure 4
Figure 4
Clinical vignettes. (formula image), No medication; (formula image), oral; (formula image), IM; (formula image), IV.
See this image and copyright information in PMC

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