scholarly journals 4123 Characterization of Physical Restraint and Sedative Use for Treatment of Agitation in the Emergency Department

2020 ◽  
Vol 4 (s1) ◽  
pp. 125-125
Author(s):  
Ambrose H Wong ◽  
Lauren Crispino ◽  
John Parker ◽  
Caitlin McVaney ◽  
Alana Rosenberg ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Tertiary Care ◽  
Physical Restraint ◽  
Overt Aggression ◽  
Emergency Setting ◽  
Severity Scale ◽  
Restraint Use ◽  
Scale Scores ◽  
Overt Aggression Scale

OBJECTIVES/GOALS: Agitation has high prevalence in the emergency department (ED), but limited evidence exists regarding clinical decisions to use sedatives and physical restraint. We examined clinical factors and agitation attributes impacting thresholds for sedative and restraint use in the emergency setting. METHODS/STUDY POPULATION: We conducted a prospective cohort study of adult patients (318 yo) with acute or escalating agitation during their ED visit at an urban tertiary care referral center. Consecutive patients requiring security presence or scoring >1 on an agitation scale were enrolled during randomized 8-h blocks. We recorded patient characteristics, staff/team factors, and environmental/systems data as well as scores on 3 validated agitation scales: Agitated Behavior Scale, Overt Aggression Scale, and Severity Scale. We performed descriptive analyses, bivariable analyses, and logistic regression modeling of factors with relation to sedative/restraint use. We observed 95 agitation events on unique patients over 2 months. RESULTS/ANTICIPATED RESULTS: Median age was 42, and 62.1% were male. Most frequent chief complaints were alcohol/drug use (37.9%) and psychiatric (23.2%). Majority of events (73.7%) were associated with sedative/restraint use. Factors related to treatment course or staff interactions were the primary reasons for agitation in 56.8% of events. A logistic regression model found no association between demographics and odds of sedative/restraint use. Overt Aggression Scale scores were associated with significantly higher odds of sedative use (AOR 1.62 [1.13–2.32]), while Severity Scale scores had significantly higher odds of restraint use (AOR 1.39 [1.12–1.73]) but significantly lower odds of sedative use (AOR 0.79 [0.64–0.98]). DISCUSSION/SIGNIFICANCE OF IMPACT: External factors may be important targets for behavioral techniques in ED agitation management. Further study of the Severity Scale may allow for earlier detection of agitation and identify causal links between agitation severity and use of sedatives and restraints.

scholarly journals Violent behaviour in schizophrenia

2005 ◽  
Vol 187 (5) ◽  
pp. 426-430 ◽  
Author(s):  
Jan Vevera ◽  
Alan Hubbard ◽  
Arnošt Veselý ◽  
Hana Papežová
Keyword(s):  
Logistic Regression ◽  
Substance Misuse ◽  
Overt Aggression ◽  
Psychotic Symptoms ◽  
Violent Behaviour ◽  
Stable Conditions ◽  
Dsm Iv ◽  
Available Information ◽  
Overt Aggression Scale ◽  
Over Time

BackgroundA number of studies have reported increased violence in patients with schizophrenia.AimsTo determine the prevalence of violence among those with schizophrenia in samples from 1949, 1969, 1989 and 2000 in Prague (Czech Republic) and to examine trends in this behaviour.MethodRecords from 404 patients meeting DSM–IV criteria for schizophrenia were screened for violence (defined as 3 points on the Modified Overt Aggression Scale) from the first observed psychotic symptoms until the time of latest available information.ResultsLogistic regression revealed a marginally significant increase in violence only inthe 2000 cohort. Overall, violence was associated with schizophrenia in 41.8% of men and 32.7% of women, with no association between substance misuse and violence.ConclusionsThe violence rate found in our sample is expected to remain stable over time under stable conditions. Substance misuse is not the leading cause of violence among those with schizophrenia.

Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department

2021 ◽  
Author(s):  
Katherine A. Nash ◽  
Destiny G. Tolliver ◽  
Richard Andrew Taylor ◽  
Amanda J. Calhoun ◽  
Marc A. Auerbach ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Physical Restraint ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Restraint Use

scholarly journals Inappropriateness of Repeated Laboratory and Radiological Tests for Transferred Emergency Department Patients

2019 ◽  
Vol 8 (9) ◽  
pp. 1342 ◽  
Author(s):  
Jérôme Bertrand ◽  
Christophe Fehlmann ◽  
Olivier Grosgurin ◽  
François Sarasin ◽  
Omar Kherad
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Laboratory Tests ◽  
Chart Review ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Emergency Department Patients ◽  
Radiological Procedures

Background: Laboratory and radiographic tests are often repeated during inter-hospital transfers from secondary to tertiary emergency departments (ED), despite available data from the sending structure. The aim of this study was to identify the proportion of repeated tests in patients transferred to a tertiary care ED, and to estimate their inappropriateness and their costs. Methods: A retrospective chart review of all adult patients transferred from one secondary care ED to a tertiary care ED during the year 2016 was carried out. The primary outcome was the redundancy (proportion of procedure repeated in the 8 h following the transfer, despite the availability of the previous results). Factors predicting the repetition of procedures were identified through a logistic regression analysis. Two authors independently assessed inappropriateness. Results: In 2016, 432 patients were transferred from the secondary to the tertiary ED, and 251 procedures were repeated: 179 patients (77.2%) had a repeated laboratory test, 34 (14.7%) a repeated radiological procedure and 19 (8.2%) both. Repeated procedures were judged as inappropriate for 197 (99.5%) laboratory tests and for 39 (73.6%) radiological procedures. Conclusion: Over half of the patients transferred from another emergency department had a repeated procedure. In most cases, these repeated procedures were considered inappropriate.

scholarly journals Patient-reported adverse drug-related events from emergency department discharge prescriptions

CJEM ◽  
2010 ◽  
Vol 12 (04) ◽  
pp. 331-338 ◽  
Author(s):  
Corinne M. Hohl ◽  
Riyad B. Abu-Laban ◽  
Peter J. Zed ◽  
Jeffrey R. Brubacher ◽  
Gina Tsai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Time Frame ◽  
Tertiary Care Centre ◽  
Crude Odds Ratio ◽  
Patient Reported ◽  
Scale Scores ◽  
Emergency Department Triage ◽  
Emergency Department Discharge ◽  
Research Assistants

ABSTRACTObjective:The tolerability of drugs prescribed on emergency department (ED) discharge is unknown. Our objectives were to quantify and describe adverse drug-related events (ADREs) as reported by patients triaged as Canadian Emergency Department Triage and Acuity Scale scores 3, 4 or 5, discharged from the ED with prescriptions.Methods:This prospective observational study was a planned substudy of a larger study on adherence to discharge prescriptions. This study was conducted in a tertiary care centre with an annual ED census of 69 000 visits. The primary outcome was the frequency of ADREs reported during a structured telephone questionnaire 2 weeks after ED discharge. An ADRE was deemed to have occurred if the patient reported a symptom consistent with a known ADRE that began and resolved within a plausible time frame after starting and stopping the drug, and if no alternative diagnosis was probable.Results:Research assistants contacted 258/301 (85.7%) patients discharged from the ED with a prescription. An ADRE was reported by 54/258 patients (20.9%, 95% confidence interval [CI] 16.4%–26.3%). The most commonly reported ADREs were nausea, constipation and drowsiness. None required hospital admission or caused death. Participants reporting ADREs were not more likely to make an unplanned ED or clinic revisit (crude odds ratio [OR] 1.1, 95% CI 0.6–2.2; adjusted OR 1.2, 95% CI 0.6–2.4).Conclusion:Approximately one-fifth of low-acuity patients prescribed medication on discharge from the ED report ADREs, but most of these are neither severe nor associated with an increase in use of health services. Attention to common preventable ADREs, such as opioid-associated constipation, could reduce the rate of ADREs in this population.

scholarly journals LO50: Can clinical examination alone rule out a central cause for acute dizziness?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S25-S26
Author(s):  
R. Ohle ◽  
A. Regis ◽  
O. Bodunde ◽  
R. LePage ◽  
Z. Turgeon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Cerebral Haemorrhage ◽  
Adult Patients ◽  
Motor Deficit ◽  
Clinical Exam ◽  
Diagnostic Codes ◽  
Ischemic Attack

Introduction: The vast majority of patients presenting with dizziness to the emergency department (ED) are due to a benign self-limiting process. However, up to 5% have a serious central neurological cause. Our goal was to assess the sensitivity of clinical exam for a central cause in adult patients presenting to the emergency department with dizziness. Methods: At a tertiary care ED we performed a medical records review (Sep 2014- Mar 2018) including adult patients with dizziness (vertigo, unsteady, lightheaded), excluding those with symptoms >14days, recent trauma, GCS < 15, hypotensive, or syncope/loss of consciousness. 5 trained reviewers used a standardized data collection sheet to extract data. Individual patient data were linked with the Institute of Clinical Evaluation Science (ICES) database. Our outcome was a central cause defined as: ischemic stroke (IS), transient ischemic attack (TIA), brain tumour, intra cerebral haemorrhage (ICH), or multiple sclerosis (MS) diagnosed on either neurology assessment, computed tomography, magnetic resonance imaging, or diagnostic codes related to central causes found within ICES. A sample size of 1,906 was calculated based on an expected prevalence of 3% with an 80% power and 95% confidence interval to detect an odds ratio greater than 2. Univariate analysis and logistic regression were performed. Results: 3,109 were identified and 2,307 patients included (mean 57 years SD ± 20, Female 59.1%, Kappa 0.91). 62 central causes (IS 56.5%, TIA 14.5%, Tumour 11.3%, MS 9.7%, ICH 6.5%) of dizziness were identified. Imaging was performed in 945(42%) and neurology assessment in 42 (1.8%). ICES yielded no new diagnoses of a central cause for dizziness. Multivariate logistic regression found 11 high-risk findings associated with a central cause; history of IS/TIA (OR 3.8 95%CI 1.7-8.2), cancer (OR 3.2 95%CI 1.4-7.2), dyslipidemia (OR 2.3 95%CI 1.2-4.4), symptoms of visual changes (OR 2.1 95%CI 1.5-6.3), dysarthria (OR 9.1 95%CI 3-27.4), vomiting (OR 2 95%CI 1-3.7), motor deficit (OR 7.7 95%CI 2.9-20.2), sensory deficit (OR 28.9 95%CI 7.4-112.9), nystagmus (OR 3.3 95%CI 1.6-6.7), ataxia (OR 2.5 95%CI 1.3-4.9) and unable to walk 3 steps unaided (OR 3.4 95%CI 1.4-8.5). Absence of these findings had a sensitivity of 100% (95%CI 92.5-100%) for ICH, IS, Tumour and 95.2% (86.5-98.9) if including TIA and MS. Specificity was 51.5% (95%CI 49.4-53.6%). Conclusion: Clinical exam is highly sensitive for identifying patients without a central etiology for their dizziness.

scholarly journals Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

2011 ◽  
Vol 33 (1) ◽  
pp. 30-39 ◽  
Author(s):  
Leonardo Baldaçara ◽  
Marsal Sanches ◽  
Daniel Cruz Cordeiro ◽  
Andrea Parolin Jackowski
Keyword(s):  
Bipolar Disorder ◽  
Overt Aggression ◽  
Severity Scale ◽  
Sedation Scale ◽  
Double Blind ◽  
Advantages And Disadvantages ◽  
Ramsay Sedation Scale ◽  
Calming Effect ◽  
Overt Aggression Scale ◽  
To Receive

OBJECTIVE: To compare the effectiveness of intramuscular olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone as the first medication(s) used to treat patients with agitation and aggressive behavior. METHOD: One hundred fifty patients with agitation caused by psychotic or bipolar disorder were randomly assigned under double-blind conditions to receive olanzapine, ziprasidone, haloperidol plus midazolam, haloperidol plus promethazine or haloperidol alone. The Overt Agitation Severity Scale, Overt Aggression Scale and Ramsay Sedation Scale were applied within 12 hours after the first dosage. RESULTS: All medications produced a calming effect within one hour of administration, but only olanzapine and haloperidol reduced agitation by less than 10 points, and only olanzapine reduced aggression by less than four points in the first hour. After twelve hours, only patients treated with haloperidol plus midazolam had high levels of agitation and aggression and also more side effects. Ziprasidone, olanzapine and haloperidol alone had more stable results for agitation control, while ziprasidone, haloperidol plus promethazine and olanzapine had stable results for aggression control. CONCLUSION: Olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol were effective in controlling agitation and aggression caused by mental illness over 12 hours. Although all the drugs had advantages and disadvantages, haloperidol plus midazolam was associated with the worst results in all the observed parameters.

scholarly journals Unfavourable outcome for children leaving the emergency department without being seen by a physician

CJEM ◽  
2013 ◽  
Vol 15 (05) ◽  
pp. 289-299 ◽  
Author(s):  
Jocelyn Gravel ◽  
Serge Gouin ◽  
Benoit Carrière ◽  
Nathalie Gaucher ◽  
Benoit Bailey
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Invasive Procedure ◽  
Pediatric Emergency ◽  
Secondary Outcome ◽  
Unfavourable Outcome ◽  
Left Without Being Seen ◽  
Chief Complaints

ABSTRACTObjective:To assess the prevalence of an unfavourable outcome among children leaving without being seen by a physician in the emergency department (ED).Method:This was a prospective cohort study conducted over a complete year in a pediatric tertiary care ED. A random sample of all children younger than 19 years of age who left without being seen by a physician was contacted by phone 4 to 6 days following the ED visit. The primary outcome was the occurrence of an unfavourable outcome prospectively defined using a Delphi method among 15 pediatric emergency physicians. An unfavourable outcome was defined as hospitalization, the need for an invasive procedure (intravenous or intramuscular medication, fracture reduction, bone casting, or surgical intervention), suicide attempt, or death in the 72 hours following leaving without being seen by a physician. As a secondary outcome, multiple potential predictors were evaluated. The first analysis evaluated the proportion of unfavourable outcomes among children who left without being seen by a physician. Then logistic regression identified predictors of unfavourable outcomes.Results:During the study period, 61,909 children presented to the ED, 7,592 (12%) left without being seen by a physician, and 1,579 were recruited. Thirty-eight (2.4%; 95% CI 1.7–3.2) patients fulfilled the criteria for an unfavourable outcome. On multiple logistic regression, chief complaints related to trauma and absence of nurse counseling had higher risks of unfavourable outcome.Conclusions:Approximately 2% of children who left without being seen by a physician at a tertiary care pediatric ED had an unfavourable outcome.

Physical Restraint Use in Adult Patients Presenting to a General Emergency Department

2019 ◽  
Vol 73 (2) ◽  
pp. 183-192 ◽  
Author(s):  
Ambrose H. Wong ◽  
R. Andrew Taylor ◽  
Jessica M. Ray ◽  
Steven L. Bernstein
Keyword(s):  
Emergency Department ◽  
Physical Restraint ◽  
Adult Patients ◽  
Restraint Use

Nursing professionals’ attitudes toward use of physical restraints in Styrian nursing homes Austria

Pflege ◽  
2019 ◽  
Vol 32 (1) ◽  
pp. 57-63
Author(s):  
Hannes Mayerl ◽  
Tanja Trummer ◽  
Erwin Stolz ◽  
Éva Rásky ◽  
Wolfgang Freidl
Keyword(s):  
Nursing Homes ◽  
Large Scale ◽  
Critical Role ◽  
Physical Restraint ◽  
Care Practice ◽  
Physical Restraints ◽  
Convenience Sample ◽  
Restraint Use ◽  
Positive Attitudes ◽  
Nursing Professionals

Abstract. Background: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals’ attitudes toward this practice. Aim: Since nursing professionals’ views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals’ attitudes concerning use of physical restraints in nursing homes of Styria (Austria). Method: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. Results: The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny “good reasons” for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals’ views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. Conclusions: Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.

Overt Aggression Scale

1986 ◽  
Author(s):  
Stuart C. Yudofsky ◽  
Jonathan M. Silver ◽  
Wynn Jackson ◽  
Jean Endicott ◽  
Daniel Williams
Keyword(s):  
Overt Aggression ◽  
Overt Aggression Scale
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