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


In summary, while agitation in the ED occurs frequently and with high costs to patients and clinical programs, there is vastly insufficient research into the understanding, prevention, assessment or treatment of agitation in this context. Further research is needed in many areas of pediatric emergency psychiatry, and especially into the comparative efficacy of different medications for agitation in different types of patients, and into the efficacy of these medications compared to placebo or to non-pharmacologic de-escalation strategies.[28–29] ED nursing and staff, pediatricians, emergency physicians, and adult psychiatrists need training in rapid diagnosis and stabilization of agitated youth, as well as support for non-pharmacologic de-escalation and crisis management. Computerized/electronic medical record-based assessment and risk stratification tools may be useful, as may be clinical pathways directed at providing support and ancillary services (child life, psychiatric, or social work consult) to at-risk youth before agitation occurs.