Acute severe behavioural disturbance (ASBD) is an emergency situation where a patient experiences severe agitation or aggression. These individuals commonly present to the emergency department (ED) for treatment. Medications are often provided to assist the person to feel calmer. In most instances, oral medications are used. When the patient is extremely agitated, an intramuscular (IM) injection will be given.
In individuals less than 18 years, there is minimal available evidence to guide doctors about which medications work best. It is also not known how well these medications are tolerated by these young people. Therefore, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network is running two trials across a number of Australian EDs to create evidence to be used to guide the treatment for these young people.
The first study (PEAChY-O) compares two oral medications - olanzapine and diazepam - to determine which medication works better. The second study (PEAChY-M) compares two IM medications – olanzapine and droperidol. These medications were chosen because they are used as standard of care in Australian EDs and are recommended on current Clinical Practice Guidelines (CPGs). These are important studies because they will be the first trials to compare any medications head-to-head in a randomised trial across either the oral or IM routes.
Once the results are available, they will be used to guide future clinical practice including influencing the recommendations made in Australian guidelines, ensuring that these young people receive evidence-based treatments.
- Bourke, E. M., Borland, M. L., Kochar, A., George, S., Shellshear, D., Jani, S., Perkins, K., Tham, D., Gordon, M. S., Klein, K., Prakash, C., Lee, K., Davidson, A., Knott, J. C., Craig, S., Babl, F. E., & Paediatric research in Emergency Departments International Collaborative (PREDICT) (2023). Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M). BMJ open, 13(3), e067436. https://doi.org/10.1136/bmjopen-2022-067436
- Bourke, E. M., Borland, M. L., Kochar, A., George, S., Shellshear, D., Jani, S., Perkins, K., Tham, D., Gordon, M. S., Klein, K., Prakash, C., Lee, K., Davidson, A., Knott, J. C., Craig, S., Babl, F. E., & Paediatric research in Emergency Departments International Collaborative (PREDICT) (2023). Pharmacological emergency management of agitation in children and young people: protocol for a randomised controlled trial of oral medication (PEAChY-O). BMJ open, 13(3), e067433. https://doi.org/10.1136/bmjopen-2022-067433
Dr Kent Perkins
Dr Elyssia Bourke
Prof Franz Babl
Prof Simon Craig