Violent-Agitated Date Last Search Run: Nov 18, 2024 Table last updated: Mar 25, 2024 Data last added: Feb 28, 2024

Recommendation		RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION		SUPPORTIVE (Green)	NEUTRAL (Yellow)	AGAINST (Red)	NOT YET GRADED (White)
	1 (strong evidence exists)				Field Restraint Devices
	2 (fair evidence exists)	Benzodiazepines Ketamine
	3 (weak evidence exists)	Antipsychotics

Interventions

Antipsychotics

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
III	Supportive (Green)	Efficacy and Safety	Patient	ED-MD	Ramsden SC, Pergjika A, Janssen AC, Mudahar S, Fawcett A, Walkup JT, Hoffmann JA. A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings. Acad Emerg Med 2022. Medline

Benzodiazepines

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
II	Supportive (Green)	Safety	Patient	PH-Paramedic	Bourke EM, Douglas N, Wilson CL, Anderson D, Nehme Z, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review. Ann Emerg Med 2023. Medline
II	Supportive (Green)	Improvement	Patient	PH-Paramedic	Sandoval S, Goyal A, Frawley J, et al. Prehospital Use of Ketamine versus Benzodiazepines for Sedation among Pediatric Patients with Behavioral Emergencies. Prehosp Emerg Care 2023;1-7. Medline

Field Restraint Devices

Level

Direction

Primary Outcome

Patient/Process

Setting

Reference

Ketamine

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
II	Supportive (Green)	Safety	Patient	PH-Paramedic	Bourke EM, Douglas N, Wilson CL, Anderson D, Nehme Z, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review. Ann Emerg Med 2023. Medline
II	Supportive (Green)	Safety	Patient	PH-Paramedic	Goyal A, Frawley J, Gappy R, Sandoval S, Chen NW, Crowe R, Swor R. Prehospital Ketamine Use in Pediatrics. Prehosp Emerg Care 2022; 1–11 Medline
II	Supportive (Green)	Improvement	Patient	PH-Paramedic	Sandoval S, Goyal A, Frawley J, et al. Prehospital Use of Ketamine versus Benzodiazepines for Sedation among Pediatric Patients with Behavioral Emergencies. Prehosp Emerg Care 2023;1-7. Medline