Pediatric Agitation in the Emergency Department: A Survey of Pediatric Emergency Care Coordinators

OBJECTIVE: Acute agitation episodes in the emergency de-partment (ED) can be distressing for patients, families, and staff and may lead to injuries. We aim to understand avail-ability of ED resources to care for children with acute agita-tion, perceived staff confidence with agitation management, barriers to use of de-escalation techniques, and desired re-sources to enhance care. METHODS: We conducted a survey of pediatric emergency care coordinators (PECCs) in EDs in Massachusetts, Rhode Island, and Los Angeles County, California. RESULTS: PECCs from 63 of 102 (61.8%) EDs responded. PECCs reported that ED staff feel least confident managing agitation due to developmental delay (DD) or autism spectrum disorder (ASD) (52.4%). Few EDs had a separate space to care for children with mental health conditions (22.5%), a standar-dized agitation scale (9.6%), an agitation management guideline (12.9%), or agitation management training (24.2%). Modification of the environment was not perceived possible for 42% of EDs. Participants reported that a barrier to the use of the de-escalation techniques distraction and verbal de-escalation was perceived lack of effectiveness (22.6% and 22.6%, respectively). Desired resources to manage agitation included guidelines for medica-tions (82.5%) and sample care pathways (57.1%). CONCLUSIONS: ED PECCs report low confidence in mana-ging agitation due to DD or ASD and limited pediatric re-sources to address acute agitation. Additional pediatric-specific resources and training, especially for children with DD or ASD, are needed to increase clinician confidence in agitation management and to promote high-quality, patient-centered care. Training programs can focus on the early identification of agitation and the effective use of non-invasive de-escalation strategies.