Pharmacotherapy considerations for pediatric acute agitation management in the emergency department

Purpose To review the current literature regarding the pharmacological management of acute agitation in pediatric patients and practical considerations when comparing agents for empiric use in the emergency department (ED).Summary ED providers play an integral role in the management of acute agitation in pediatric patients. The development of acute agitation is multifactorial, and patients may quickly escalate upon arrival or while boarding in the ED. Non-pharmacological de-escalation strategies should be prioritized. If a patient poses a safety risk to themself or staff members, the administration of pharmacological treatment may be necessary to target the underlying cause and allow for the patient to safely engage in assessment and treatment. There is limited guidance regarding medication selection and dosing for acute agitation in pediatrics despite being a key facet of multimodal management.Conclusion The literature regarding pharmacotherapy for acute agitation management in pediatric patients remains scarce. Medications utilized vary depending on institutional practice as well as provider preference. Evidence suggests that implementing an institutional protocol for pediatric acute agitation in the ED may improve patient outcomes. Additional studies are needed optimize the pharmacological management of acute pediatric agitation and patient outcomes in the ED.