Characteristics and Severity of Agitation Associated With Use of Sedatives and Restraints in the Emergency Department
| Autor: | Caitlin McVaney, Alana Rosenberg, Travis Whitfill, Ambrose H. Wong, John B. Parker, Joanne DeSanto Iennaco, Lauren Crispino, Steven L. Bernstein, Jessica M. Ray |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Restraint Physical medicine.medical_specialty medicine.drug_class Aggression Scale Logistic regression Odds 03 medical and health sciences 0302 clinical medicine Odds Ratio Medicine Humans Hypnotics and Sedatives 030212 general & internal medicine Prospective Studies Psychomotor Agitation business.industry 030208 emergency & critical care medicine Emergency department Odds ratio Middle Aged Triage Logistic Models Sedative Emergency medicine Emergency Medicine Observational study Female business Emergency Service Hospital |
| Zdroj: | The Journal of emergency medicine. 57(5) |
| ISSN: | 0736-4679 |
| Popis: | Background Agitated patients frequently present to emergency departments, but limited evidence exists regarding clinical decisions to use chemical sedatives and physical restraints. Objective We examined attributes and levels of agitation impacting thresholds for sedative and restraint use in the emergency setting. Methods This was a secondary study focusing on agitation characteristics within a prospective observational study of agitated patients in the emergency department at an urban, tertiary referral center. We recorded scores on 3 validated agitation scales: the Agitated Behavior Scale, the Overt Aggression Scale, and the Severity Scale. Consecutive patients requiring security presence or scoring ≥1 on an agitation scale were enrolled during randomized 8-h blocks. Results Ninety-five agitation events on unique patients were observed. The median age was 42 years, and 62.1% were male. Highest frequency triage chief complaints were alcohol/drug use (37.9%) and psychiatric (23.2%). Most events (73.7%) were associated with sedative or restraint use. Factors related to treatment course or interactions with staff were commonly cited (56.8%) as the primary etiology for agitation. A logistic regression model found no association between demographics and odds of sedative/restraint use. Overt Aggression Scale scores were associated with significantly higher odds of sedative use (adjusted odds ratio [AOR] 1.62 [range 1.13–2.32]), while Severity Scale scores had significantly higher odds of restraint use (AOR 1.39 [range 1.12–1.73]) but significantly lower odds of sedative use (AOR 0.79 [range 0.64–0.98]). Conclusion External factors may be important targets for behavioral techniques in agitation management. Further study of the Severity Scale scale may allow for earlier detection of agitation and identify causal links between agitation severity and use of sedatives and restraints. |
| Databáze: | OpenAIRE |
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