Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department

Consensus Statement of the American Association for Emergency Psychiatry

Ruth Gerson, MD; Nasuh Malas, MD, MPH; Vera Feuer, MD; Gabrielle H. Silver, MD; Raghuram Prasad, MD; Megan M. Mroczkowski, MD; Pediatric BETA Consensus Guideline Working Group


Western J Emerg Med. 2019;20(2):409-418. 

In This Article


Study Design and Setting

Given the dearth of child psychiatrists in the U.S., this workgroup focused on the consensus of a group of experts in this subspecialty. The workgroup was assembled from experts in emergency child and adolescent psychiatry and psychopharmacology from the AAEP, the American Academy of Child and Adolescent Psychiatry (AACAP) Emergency Child Psychiatry Committee, and peer recommendation. Sixteen experts participated, all board certified in child and adolescent psychiatry with some additionally board certified in pediatrics. The experts represented 14 hospitals in eight states.


The non-voting project chair (RG) facilitated discussion, information gathering, and consensus building. Consensus was obtained using consensus development methodology, specifically the Delphi method, which was developed to obtain reliable opinion consensus and avoid bias.[19–20] Per the Delphi method, opinions were elicited from the experts through a series of emailed questionnaires and structured solicitation of feedback. There were six rounds of questionnaires and feedback in total, starting with determining the structure of the guidelines (by age/weight, medication class, severity or etiology of agitation), and then narrowing progressively to choose the assessment strategies, etiologic categories, medications, doses, and cautions noted below. In the first of these rounds of questionnaires, experts assessed the standardized review of the existing literature on management of agitation summarized above, as well as published and unpublished guidelines and protocols used by EDs across the country (solicited through AAEP, AACAP, and outreach to several EDs and experts in the field). All opinions were anonymized and aggregated by the project chair to avoid direct confrontation between experts and prevent bias. This manuscript also underwent two rounds of workgroup feedback.