Access to psychiatric and psychological treatment for youth is inadequate.1 The dearth of early, effective interventions contributes to psychiatric exacerbations in youth, leaving families and schools to seek emergent care in emergency medicine departments.2 Youth commonly present to the emergency medicine department with agitation or become agitated during evaluation.3 Behavioral interventions may not be successful in this setting, and rapid, effective approaches to protect the patient and others are a necessity. In these situations, restraints may be necessary, but these events often are emotionally charged and can be very distressing to patients, families, and medical staff.3 Unfortunately, there are gaps in the literature regarding high-quality evidence comparing the efficacy of various pharmacologic and nonpharmacologic approaches with managing agitation in youth. Pharmacologic restraints in this study were defined as medications cited in the literature as being used for pediatric pharmacologic restraint and administered intramuscularly or intravenously. Medications delivered via other routes were excluded from the study due to the uncertainty regarding whether the medication was truly used as a restraint, as these medications could have alternative indications or be the patient’s regularly scheduled medications.


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