S'abonner

The Characteristics and Prevalence of Agitation in an Urban County Emergency Department - 19/09/18

Doi : 10.1016/j.annemergmed.2018.06.001 
James R. Miner, MD , Lauren R. Klein, MD, Jon B. Cole, MD, Brian E. Driver, MD, Johanna C. Moore, MD, Jeffrey D. Ho, MD
 Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 

Corresponding Author.

Abstract

Study objective

We seek to determine the characteristics and prevalence of agitation among patients in an urban county emergency department (ED).

Methods

This was a prospective observational study of ED patients at an urban Level I trauma center. All ED patients were screened during daily randomized 8-hour enrollment periods. Adult agitated patients, defined as having an altered mental status score greater than 1, were included. Trained research volunteers collected demographics and baseline data, including the presenting altered mental status score, use and type of restraints, and whether any initial sedative was given. The altered mental status score, vital signs, and any medications or treatments given were recorded every 5 minutes thereafter until the patient had an altered mental status score less than 1. Providers were asked to describe clinical events resulting in an intervention occurring during the patient course, including hypotension, vomiting, increased monitoring, use of supplemental oxygen or airway adjunct, or intubation. The provider also completed a checklist to determine the presence of delirium symptoms.

Results

A total of 43,838 patients were screened (45.1% women; median age 33 years; range 0 to 102 years). The prevalence of agitation was 2.6% (1,146/43,838; median altered mental status score 2). Of these patients, 84% (969/1,146) required physical restraint and 72% (829/1,146) required sedation with an intramuscular injection. Sedative agents were olanzapine in 39% of patients (442/1,146), droperidol in 20% (224/1,146), haloperidol in 20% (226/1,146), a benzodiazepine in 6% (68/1,146), and ketamine in 5% (52/1,146). Delirium characteristics were observed in 0.6% of patients (260/43,838), representing 23% of agitated patients in the ED. Clinical events were observed in 13% of agitated patients (114/866) without delirium symptoms and 26% (68/260) with delirium symptoms. Characteristics associated with a clinical event included delirium symptoms (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.2 to 2.4), a cause related to a drug other than alcohol (OR 1.7; 95% CI 1.1 to 2.9), or a nondrug-induced cause of agitation (OR 3.5; 95% CI 2.3 to 5.6).

Conclusion

The prevalence of agitation in the ED was 2.6%. Agitated patients frequently required restraint and sedation, with significant rates of clinical events requiring intervention.

Le texte complet de cet article est disponible en PDF.

Plan


 Please see page 362 for the Editor’s Capsule Summary of this article.
 Supervising editor: Megan L. Ranney, MD, MPH
 Author contributions: JRM is the guarantor of the integrity of the entire study. JRM, JBC, BED, JCM, and JDH developed the study concept. JRM, JBC, JCM, and JDH developed the study design. JRM, JBC, and JDH defined intellectual content. JRM, LRK, BED, JCM, and JDH conducted data acquisition. JRM, LRK, and JCM conducted data analysis and prepared the article. JRM and LRK wrote the article. All authors conducted experimental studies and edited and reviewed the article. JRM takes responsibility for the paper as a whole.
 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.
 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 work was sponsored by a grant from the National Institute of Justice.
 Trial registration number: NCT01747824
 Readers: click on the link to go directly to a survey in which you can provide PZ2LKRR to Annals on this particular article.


© 2018  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 72 - N° 4

P. 361-370 - octobre 2018 Retour au numéro
Article précédent Article précédent
  • Resuscitative Endovascular Balloon Occlusion of the Aorta Improves Cardiac Compression Fraction Versus Resuscitative Thoracotomy in Patients in Traumatic Arrest
  • William Teeter, Anna Romagnoli, Philip Wasicek, Peter Hu, Shiming Yang, Deborah Stein, Thomas Scalea, Megan Brenner
| Article suivant Article suivant
  • Agitation Crisis Control
  • Jessica Mason, Christopher B. Colwell, Andrew Grock

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2025 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.