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35th AM (2025) - Poster Session
Impact of Substance Use on the Emergency Managemen ...
Impact of Substance Use on the Emergency Management of Pediatric Agitation
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Pdf Summary
This retrospective study evaluated 150 pediatric patients (under 18) who received intramuscular antipsychotics for agitation in emergency or inpatient psychiatric settings at Mount Sinai between 2019 and 2023. Patients were divided into groups with or without co-occurring substance use, primarily cannabis (44.7%), nicotine (36.2%), and alcohol (36.2%). The substance use group was older (mean age 14.1 vs. 11.3 years), more often male, and presented more frequently with police involvement (40% vs. 9%) and in the emergency department rather than inpatient unit (68% vs. 49%). This group also had higher rates of depressive (13% vs. 9%), impulsive behavioral (21% vs. 17%), and substance use disorders (19% vs. 0%).<br /><br />Despite these differences in demographics, clinical presentation, and diagnosis, treatment outcomes were similar between groups. Both cohorts showed comparable efficacy of antipsychotic management, with similar rates of additional medication needed within 24 hours, restraint or seclusion use, and adverse reactions. The type of antipsychotic used (mostly chlorpromazine or haloperidol) and co-administration of benzodiazepines or diphenhydramine did not significantly differ. Safety measures such as vital signs and documented side effects were also comparable.<br /><br />The study highlights that substance use is associated with distinct sociodemographic and clinical features in pediatric patients presenting with agitation; however, it does not significantly alter the immediate efficacy or safety of intramuscular antipsychotic treatment in emergency settings. These findings emphasize the need for tailored management approaches addressing the unique aspects of substance use in youth but support the current emergency pharmacologic interventions' effectiveness irrespective of substance use status.<br /><br />Future research should focus on long-term outcomes and optimizing treatment strategies for this vulnerable population, considering the complex interplay between substance use, psychiatric comorbidities, and acute agitation.
Keywords
pediatric agitation
intramuscular antipsychotics
substance use
cannabis
nicotine
alcohol
emergency psychiatric treatment
psychiatric comorbidities
treatment efficacy
safety outcomes
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