- Design
- Retrospective single-centre case series
- Population
- 20 adolescents aged 12-17 with severe agitation in the ED
- Primary outcome
- Need for additional sedation during infusion
- Effect
- 9 of 20 (45%, 95% CI 26-66%); 5 transferred to PICU
This single-centre Italian case series described 20 adolescents aged 12 to 17 with severe agitation given a dexmedetomidine infusion in the emergency department while awaiting psychiatric care. Median infusion time was 21 hours at a median maximum of 1.6 micrograms/kg per hour.
Nine (45%) still needed additional sedation, one had a desaturation that resolved with repositioning and oxygen, and five were transferred to paediatric intensive care because they needed several sedatives.
This is a small retrospective series without a comparison group. It shows the approach is possible with monitoring, not that it is better than intermittent sedation.
- Use verbal de-escalation and environmental measures first for agitated adolescents.
- Consider dexmedetomidine infusion only with continuous monitoring and staff trained to use it.
- Expect about half to need additional sedation.
- Plan early psychiatric review and disposition; prolonged emergency department stays drive the need for sedation.
Why it matters
Long waits for psychiatric beds leave emergency departments sedating adolescents for many hours, and options are limited.
The statistics, in plain English
With 20 patients, the 45% needing more sedation has a wide range of plausible values (26% to 66%).
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