{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Emergency Research Group, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia",
        "Department of Emergency Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Kate Klein"
    },
    {
      "affiliations": [
        "Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia",
        "Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia",
        "Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Christopher Selman"
    },
    {
      "affiliations": [
        "Pediatric Emergency, Women and Children’s Hospital Adelaide, North Adelaide, South Australia, Australia",
        "Acute Care Medical, University of Adelaide, Adelaide, South Australia, Australia"
      ],
      "name": "Amit Kochar"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Queensland Children’s Hospital, Brisbane, Queensland, Australia"
      ],
      "name": "Deborah Shellshear"
    },
    {
      "affiliations": [
        "Emergency Medicine, Perth Children’s Hospital, Nedlands, Western Australia, Australia",
        "Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia"
      ],
      "name": "Meredith Louise Borland"
    },
    {
      "affiliations": [
        "Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia",
        "School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia",
        "Department of Emergency Medicine and Children’s Critical Care, Gold Coast University Hospital, Southport, Queensland, Australia"
      ],
      "name": "Shane George"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia",
        "Children’s Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Shefali Jani"
    },
    {
      "affiliations": [
        "Emergency Research Group, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia",
        "Department of Emergency Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia",
        "Emergency Medicine, Western Health, Sunshine, Victoria, Australia"
      ],
      "name": "Doris Tham"
    },
    {
      "affiliations": [
        "Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia",
        "Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Katherine Lee"
    },
    {
      "affiliations": [
        "Emergency Research Group, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia",
        "Paediatric Emergency, Monash Medical Centre Clayton, Clayton, Victoria, Australia",
        "Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Simon Craig"
    },
    {
      "affiliations": [
        "Emergency Research Group, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia",
        "Department of Emergency Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia",
        "Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia",
        "Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Franz E Babl"
    },
    {
      "affiliations": [
        "Emergency Research Group, Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia",
        "Department of Emergency Medicine, The Royal Children’s Hospital, Melbourne, Victoria, Australia",
        "Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia",
        "Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia",
        "Department of Emergency Medicine, Ballarat Base Hospital (Grampians Health Services), Ballarat, Victoria, Australia",
        "Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Elyssia M Bourke"
    }
  ],
  "title": "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",
  "uid": "72e8297f-4892-5783-890f-547056cc345a"
}