Pharmacotherapy considerations for pediatric acute agitation management in the emergency department.

ABSTRACT

DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To review the current literature regarding the pharmacological management of acute agitation in pediatric patients and practical considerations when comparing agents for empiric use in the emergency department (ED). SUMMARY: ED providers play an integral role in the management of acute agitation in pediatric patients. The development of acute agitation is multifactorial, and patients may quickly escalate upon arrival or while boarding in the ED. Nonpharmacological de-escalation strategies should be prioritized. If a patient poses a safety risk to themself or staff members, the administration of pharmacological treatment may be necessary to target the underlying cause and allow for the patient to safely engage in assessment and treatment. There is limited guidance regarding medication selection and dosing for acute agitation in pediatrics despite being a key facet of multimodal management. CONCLUSION: The literature regarding pharmacotherapy for acute agitation management in pediatric patients remains scarce. Medications utilized vary depending on institutional practice as well as provider preference. Evidence suggests that implementing an institutional protocol for pediatric acute agitation in the ED may improve patient outcomes. Additional studies are needed optimize the pharmacological management of acute pediatric agitation and patient outcomes in the ED.