46 - The Agitated Pediatric Patient Located In the ED: The APPLIED Observational Study

Poster Number: 46
Publication Number: 46.103

Matthias M. Manuel, University of Texas Southwestern Medical School, Dallas, TX, United States; Sing-Yi Feng, University of Texas Southwestern Medical School, Dallas, TX, United States; Kenneth Yen, University of Texas Southwestern Medical School, Dallas, TX, United States; FAISALMOHEMED N. PATEL, Children's Health, FRISCO, TX, United States

Background: Focused research on pediatric agitation is lacking, despite being a common mental and behavioral health (MBH) emergency. Prevalence of pediatric agitation remains unknown and prior reports may have underestimated rates of restraint use for acute agitation.

Objective: To provide a focused evaluation of the prevalence and predictors of pediatric agitation and restraint use, as well as ED length-of-stay (EDLOS) and admission rate for agitated patients.

Design/Methods: We reviewed records of patients ≤18 years with MBH needs who visited the pediatric-ED of a tertiary-care-hospital over a 3-year-period. We identified and ascertained agitated/aggressive patients using clinical encounter documentation, disease diagnostic codes, and behavioral-activity-rating-scale (BARS) scores. We performed appropriate descriptive and multivariable logistic regression analyses using SAS-9.4®

Results: Of 10,172 patients with MBH needs, 1408 (13.8%) were agitated/aggressive. Of these (n=1408), 63.7% were males and mean age was 11.9 years. Among agitated patients, prevalence of restraint use was 28.7%, with predominance of pharmacologic restraint with atypical antipsychotics. Non-Hispanic Blacks were more likely to be agitated (aOR:1.8, CI:1.2-2.7), but not restrained (aOR:0.8, CI:0.3-1.8). Multivariable predictors of restraint use among agitated patients include, history of ADHD-(aOR:2.2, CI:1.5-3.3), autism-(aOR:2.9, CI:1.9-4.5), conduct disorder-(aOR:1.7, CI:1.2-2.5), psychosis-(aOR:14.3, CI:2.5-271.8), and substance use/overdose states-(aOR:1.9, CI:1.2-3.2). Restrained agitated patients had longer EDLOS-(8.4 vs. 5.0 hours, p< .0001) and higher admission rates-(aOR:2.6, CI:2.0-3.5). Depression-(aOR:0.4, CI:0.3-0.5) and suicidality-(aOR:0.2, CI:0.1-0.3) were protective against agitation and restraint use.Conclusion(s): Prevalence of acute agitation and restraint use in pediatric-EDs may be higher than previously reported. Predictors of acute agitation and restraint use among MBH patients were consistent with prior reports. Restrained agitated patients had longer EDLOS and admission-rate.
CV_Matthias.ManuelMatthias_Manuel_ CV.1.5.2022.pdf
Predictors of admission for agitated patients