Patients in a state of agitation in a hospital emergency ward

OBJECTIVE: To determine the incidence and causes of agitation states in pat ients presenting at the Rouen University Hospital emergency room and to ana lyze the management scheme. PATIENTS AND METHOD: A prospective study was conducted over a 9 month perio d in 100 consecutive patients presenting a state of agitation assessed usin g the Overt Aggression Scale A pre-planned management protocol was applied. RESULTS: The incidence of states of agitation was 0.56%. There were 43 wome n and 57 men, mean age 33 years. Most of the agitated patients were admitte d between 6 p.m. and 4 a.m. (69%). Over the 9 month period, 2 patients were admitted twice for agitation and 2 absconded. Low glucose level was the ca use of agitation in 4 cases. Alcohol and/or drug use concerned 73% of the a gitated patients and was the most frequently observed triggering factor (17 %). Only 6% of the patients had a regular employment Physical restraining m easures and sedation were required in 86% and 84% of the cases respectively . Among 67 patients given loxapine far sedation, 2 developed acute dyskines ia and 9 low blood pressure One out of 4 patients were referred to a psychi atric unit CONCLUSION: Patients in a state of agitation are young, often female, and i n a difficult socio-economic situation. Hypoglycemia is the main differenti al diagnosis. A triggering factor can often be identified. A state of agita tion is not a repetitive condition but occurs as a short-lived episode in t he patientis history. Such patients need rapid care to avoid further aggrav ation and disruption of the emergency room activity, and to prevent the pat ient from fleeing. Loxapine provides effective sedation but requires regula r monitoring of blood pressure and can provoke acute dyskinesia in young su bjects.