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Agitation and Restraint in a Pediatric Psychiatric Emergency Program: Clinical Characteristics and Diagnostic Correlates

Agraharkar, Shilpa; Horwitz, Sarah; Lewis, Kristen; Goldstein, Gabriella; Havens, Jennifer; Gerson, Ruth
OBJECTIVES/OBJECTIVE:Agitation and restraint among pediatric psychiatric patients are a frequent, yet little studied, source of morbidity and, rarely, mortality in the emergency department (ED). This study examined agitation and restraint among youth patients in a specialized pediatric psychiatric ED, considering clinical and sociodemographic characteristics of those who required restraint to determine the clinical correlates of agitation and restraint in this population. METHODS:This descriptive study was a 6-year retrospective chart review of all patients restrained for acute agitation. Demographics, clinical characteristics, diagnoses, and reasons for restraint were collected. Relationships between sociodemographic and clinical variables to types of restraints used were examined, along with change over the study period in rate of and mean time in restraint. RESULTS:The average restraint rate was 1.94%, which remained fairly consistent throughout study period, although average time in restraint decreased significantly. Restraints were more common in males. Adolescents were overrepresented in the ED population, and after controlling for this, restraint rates were similar in adolescents and younger children. Physical aggression was the most frequent precipitant, although among adolescents verbal aggression was also a precipitant (more so than in younger children). Disruptive behavior disorder diagnoses were most frequently associated with restraint. CONCLUSIONS:A lower rate of restraint is reported here than has been seen in programs where youths are treated in medical or adult psychiatric EDs. Hospitals without specialized pediatric psychiatric emergency programs should invest in staff training in deescalation techniques and in access to pediatric psychiatric treatment. The finding that, of youth restrained, a significant proportion were under 12 years old and/or carried diagnoses not typically associated with aggressive behavior, indicates that crisis prevention, management, and treatment should include younger populations and diverse diagnostic groups, rather than focusing narrowly on older patients with psychotic or substance use disorders.
PMID: 34908377
ISSN: 1535-1815
CID: 5108542


Agraharkar, S
Objectives: There has been a dramatic increase in pediatric patients presenting to emergency departments (EDs) for mental health crises, including suicidal ideation and attempts. These youths are often seen in medical EDs or in adult mental health EDs and frequently are not seen by child and adolescent psychiatrists across the United States. The goal of this presentation is to offer clinicians an example of a Children's Comprehensive Psychiatric Emergency Program (CCPEP) and to highlight the particular benefits that this program can offer.
Method(s): This presentation will discuss the various services that a specialized mental health emergency program offers, including connection to care via interim crisis clinic and case management, along with extended observations that can be used to assess safety in suicidal patients.
Result(s): Patients are seen in the CCPEP for a variety of reasons, predominantly because the patient is in crisis. Patients require admission to the inpatient unit, but in a minority of cases they can be discharged immediately after evaluation or admitted for a brief observation.
Conclusion(s): The additional services provided by the CCPEP can reduce lengths of stay and can more quickly connect patients to outpatient services, diminishing the need for longer-term mental health hospitalization. S, TREAT
ISSN: 1527-5418
CID: 4131172