608 - Epidemiology of children and adolescents presenting to Australian Emergency Departments for the management of acute severe behavioral disturbance: Secondary analysis of a randomized controlled trial.

Publication Number: 1585.608

Elyssia M. Bourke, Melbourne Health, Melbourne, Victoria, Australia; Kate Klein, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Chris J. Selman, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Amit Kochar, Womens And Childrens Hospital, ADELAIDE, South Australia, Australia; Deborah Shellshear, Queensland Children’s Hospital, Brisbane, Queensland, Australia; Meredith L. Borland, University of Western Australia, Nedlands, Western Australia, Australia; Shane George, Griffith University, Gold Coast, Queensland, Australia; Shefali Jani, SCHN, Castle Hill, New South Wales, Australia; Doris Tham, The Royal Children's Hospital, Melbourne; Sunshine Hospital, Western Health, Melbourne, Victoria, Australia; Katherine J. Lee, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Simon Craig, Monash University, Clayton, Victoria, Australia; Franz E. Babl, The Royal Children's Hospital, Melbourne, Victoria, Australia

Background: Presentations of acute severe behavioural disturbance to emergency departments (EDs) are increasing amongst children and adolescents. There is limited understanding of the epidemiology of these critical events or evidence to guide their management.

Objective: To describe the epidemiological characteristics of children and adolescents presenting to the emergency department (ED) with acute severe behavioral disturbance (ASBD) who required oral sedative medication.

Design/Methods: Secondary analysis of a randomized, controlled, open-label, multi-centre trial (RCT) of oral olanzapine versus oral diazepam for the management of ASBD in children and adolescents aged 9 to 17 years.

Results: There were 348 participants enrolled in the RCT. The majority were female (215/348, 62%) with a mean age of 14.6 years (standard deviation 2.2) (Table 1). The most common pre-existing medical or mental health condition was anxiety (122/299, 35%) followed by attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (33% and 32%, respectively). Two-thirds of the study population (216/348, 62%) had previously attended the ED for ASBD management and another two-thirds (212/348, 61%) reported previous intentional self-harm. Nearly three-quarters (247/348, 71%) were accessing psychiatric care in the community prior to their ED presentation. Half of the study population (178/348, 52%) presented to the ED with emergency services (e.g. ambulance, police). The median length of stay in the ED was 5.7 hours (interquartile range 3.9-10.2 hours) and 28% (98/348) of study participants required admission to hospital (Table 2).

Conclusion(s): For children and adolescents presenting to the ED with ASBD, who were deemed to require oral sedative medication to assist with behavioral containment, pre-existing mental health disorders were common. There is a need for more targeted, conditions-focused care for children and adolescents presenting to the ED with ASBD and for support and education in the pre-hospital setting.

Table 1: Baseline characteristics of youth in the Emergency Department (ED) deemed to be in a state of acute severe behavioral disturbance (based on a SAT score ≥+1) who required oral sedation for management and were enrolled in the PEAChY-O trial.


Table 2: Epidemiological characteristics of participants enrolled in the PEAChY-O trial prior to arrival to ED.