Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review - 20/10/23
, Ned Douglas, MBBS b, d, Catherine L. Wilson, MPH, Ms.Eval. Assess a, David Anderson, MBChB, FCICM e, f, g, Ziad Nehme, PhD e, f, Franz E. Babl, MD, MPH a, b, h, ion behalf of the
Paediatric Research in Emergency Departments International Collaborative (PREDICT)
Abstract |
Study Objectives |
To describe the epidemiological factors of mental health presentations in young people to emergency medical services (EMS) and define those experiencing acute severe behavioral disturbance by reviewing parenteral sedation use.
Methods |
We performed a retrospective review of records of EMS attendance for young people (aged <18 years) with mental health presentations between July 2018 and June 2019 to a statewide EMS system in Australia of a population of 6.5 million persons. In addition, epidemiological data and information about parenteral sedation for acute severe behavioral disturbance and any adverse events were extracted from the records and analyzed.
Results |
A total of 7,816 patients had mental health presentations with a median age of 15 years (IQR 14-17). The majority (60%) were female. These presentations accounted for 14% of all pediatric presentations to EMS. Out of them, 612 (8%) received parenteral sedation for acute severe behavioral disturbance. A number of factors were associated with increased odds of parenteral sedative medication being used, including autism spectrum disorder (odds ratio [OR] 3.3; confidence interval [CI], 2.7 to 3.9), posttraumatic stress disorder (OR 2.8; CI, 2.2 to 3.5) and intellectual disability (OR 3.6; CI, 2.6 to 4.8). The majority (460, 75%) of young people received midazolam as their first-line medication, with the remaining patients being provided ketamine (152, 25%). No serious adverse events were noted.
Conclusion |
Mental health conditions were a common presentation to EMS. A history of autism spectrum disorder, posttraumatic stress disorder, or an intellectual disability increased the odds of receiving parenteral sedation for acute severe behavioral disturbance. Sedation appears generally safe in the out-of-hospital setting.
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| Please see page 547 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: EMB and FEB conceived the study. ZN and CLW obtained ethics and governance approval for the study. FEB and ZN obtained the data. EMB and ND cleaned, analyzed, and interpreted the data. EMB drafted the initial manuscript, with all authors contributing substantially to its revision. EMB takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was funded in part by a grant from the National Health and Medical Research Council (NHMRC ID:1171228), Canberra, Australia, and supported by the Victorian Government’s Infrastructure Support Program. EMB is supported by a NHMRC postgraduate scholarship. ZN is supported by a National Heart Foundation fellowship. FEB is supported by a NHMRC Investigator Grant (ID:2017605) and the Royal Children’s Hospital Foundation, Parkville, Australia. |
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| Data sharing statement: The authors support data sharing. This study utilized identifiable individual patient data that are subject to restrictions due to ethics and privacy. Anonymized participant data will be available on request from the corresponding author where possible within these constraints for use. |
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Vol 82 - N° 5
P. 546-557 - novembre 2023 Ritorno al numero
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