title: National Survey on Pediatric Acute Agitation and Behavioral Escalation in Academic Inpatient Pediatric Care Settings.
abstract: Pediatric acute agitation and behavioral escalation (PAABE) is common and disruptive to pediatric inpatient health care. There is a paucity of literature on PAABE in noncritical care inpatient pediatric care settings with little consensus on its evaluation and management.
  
  
  
  In January 2016, a 34-question survey was e-mailed to pediatric hospitalists and consultation-liaison psychiatrists through their respective professional listservs. Excluded responses included incomplete surveys, and surveys from providers in community care settings. The survey consisted of multiple-choice questions, rating scales, and free-text responses relating to the identification, education, and evaluation and management of PAABE at the respondent's respective hospital.
  
  
  
  Responses were obtained from 38 North American academic children's hospitals. Of the respondents, 69.3% were pediatric hospitalists and 30.7% were pediatric psychiatry consultants. Most respondents practice in urban areas (84.2%), and in hospitals with ≥100 beds (89.4%). Overall, 84.2% of the respondents encountered PAABE at least once a month and as frequently as every week. Most respondents (70.0%) rated PAABE as an 8 or higher on a 10-point Likert scale. Despite being highly important and common, 53.9% of respondents do not screen for risk factors for PAABE, 63.6% reported no formal process to facilitate caregiver involvement in managing PAABE, and 59.7% indicated no physician training in PAABE evaluation and management.
  
  
  
  Many pediatric hospitals identify PAABE as a great concern, yet there is little training, screening, or standardization of care in PAABE. There is a need to consolidate existing knowledge regarding PAABE, while developing enhanced collaboration, training, and standardized practice in inpatient PAABE.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, MI. Electronic address: nmalas@med.umich.edu.
authors.forename: Nasuh
authors.initials: N
authors.lastname: Malas
authors.affiliation: Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI.
authors.forename: Linden
authors.initials: L
authors.lastname: Spital
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, MI.
authors.forename: Jason
authors.initials: J
authors.lastname: Fischer
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI.
authors.forename: David
authors.initials: D
authors.lastname: Cruz
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, MI; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
authors.forename: Patricia
authors.initials: P
authors.lastname: Keefer
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D002648:Child; D002673:Child, Hospitalized / Q000523:psychology* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D000066553:Problem Behavior / Q000523:psychology*; D011595:Psychomotor Agitation / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: aggression; agitation; consultation psychiatry; hospital medicine; inpatient; pediatric