Non-pharmacological de-escalation techniques used to manage acute severe behavioural disturbance in children and adolescents presenting to emergency departments: secondary analysis of a randomised controlled trial
Year: 2025
Type: article
Abstract: OBJECTIVE: To describe the frequency and nature of non-pharmacological de-escalation methods used for children and adolescents presenting to emergency departments (EDs) with acute severe behavioural disturbance (ASBD). DESIGN: Secondary analysis of a randomised, controlled, open-label, multicentre trial of oral olanzapine versus oral diazepam for the management of ASBD. SETTING: Nine EDs in Australia between October 2021 and November 2023. PARTICIPANTS: Children aged 9-17 years, for whom information on non-pharmacological de-escalation attempts was recorded, who ultimately required oral sedative medication to manage their ASBD. MAIN OUTCOME MEASURES: The frequency and nature of the use of non-pharmacological de-escalation methods for children and adolescents presenting to EDs in a state of ASBD. RESULTS: There were 348 participants enrolled in the randomised controlled trial. This study reports on the 337 of 348 participants (97%) for whom information was recorded regarding non-pharmacological de-escalation attempts during the trial period. Verbal de-escalation was the most commonly attempted technique (96%) followed by active listening (75%). The frequency and nature of de-escalation techniques used were similar across the nine participating sites. CONCLUSIONS: A variety of non-pharmacological de-escalation strategies are used among patients who require oral sedative medication. There is a need for studies to investigate whether there are optimal first-line de-escalation strategies and to determine their effectiveness and order of use in children and adolescents presenting to EDs with ASBD.
Source: Archives of Disease in Childhood
Institutions: Royal Children's Hospital, Murdoch Children's Research Institute, The University of Melbourne, Women's and Children's Hospital, Women's and Children's Health Network, The University of Adelaide, Children's Health Queensland Hospital and Health Service, The University of Western Australia, Princess Margaret Hospital for Children, Perth Children's Hospital, Griffith University, Gold Coast Hospital, Gold Coast Health, The University of Sydney, Children's Hospital at Westmead, Western Health, Monash Medical Centre, Monash University, The Royal Melbourne Hospital, Grampians Health
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4414575780