Acute behavioural disturbance and agitation — branching viva

Branching viva on classifying acute agitation by severity and cause, the least-restrictive ladder, verbal de-escalation, oral and parenteral pharmacotherapy grounded in the PEAChY trials, excluding organic causes, and minimising and recovering from restraint.

branching clinical structured oral3 min readVerification in progress

Prompt

You are the paediatric registrar in the emergency department. The examiner moves from classification to the least-restrictive ladder, pharmacotherapy, organic-cause exclusion, and a restraint-and-recovery scenario.

Stem

The examiner will test whether you can classify acute agitation, run the least-restrictive ladder, choose pharmacotherapy with evidence, exclude organic causes, and manage restraint and recovery safely. [1] [3]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References8Show ledger

[1]Gerson R 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. West J Emerg Med, 2019.PMID 30881565
[2]Hoffmann JA Pharmacologic Management of Acute Agitation in Youth in the Emergency Department. Pediatr Emerg Care, 2021.PMID 34397677
[3]Foster AA Approach to acute agitation in the pediatric emergency department. Curr Opin Pediatr, 2024.PMID 38299972
[4]Mills KP Pharmacotherapy considerations for pediatric acute agitation management in the emergency department. Am J Health Syst Pharm, 2024.PMID 39008306
[5]Bourke EM PEAChY-O: Pharmacological Emergency Management of Agitation in Children and Young People: A Randomized Controlled Trial of Oral Medication. Ann Emerg Med, 2025.PMID 39955661
[6]Bourke EM Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M). BMJ Open, 2023.PMID 36997241
[7]Klein K Non-pharmacological de-escalation techniques used to manage acute severe behavioural disturbance in children and adolescents presenting to emergency departments: secondary analysis of a randomised controlled trial. Arch Dis Child, 2026.PMID 41015487
[8]Perers C Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care. Psychiatr Q, 2022.PMID 33629229