Methodology: 3.5/5
Usefulness: 3/5
Bourke EM, et al. Ann Emerg Med. 2025 Jul;86(1):1-11. doi: 10.1016/j.annemergmed.2025.01.007.
Question and Methods: In this randomized, open-label, multicentre trial, the authors investigated whether oral olanzapine was more effective than oral diazepam for achieving sedation in acutely agitated children and adolescents, aged 9-17 years old. The primary outcome was successful sedation (Sedation Assessment Tool score of 0) at one-hour post-randomization without the need for additional medications.
Findings: Successful sedation without the requirement for additional sedatives occurred in 61% in the olanzapine group and 57% in the diazepam group. No serious adverse events were reported in either group.
Limitations: Due to the open-label design, this trial was not blinded and is at risk of bias. Additional limitations include lack of details regarding alternative strategies for de-escalation or agitation management, as well as outcomes relating to escalating violence management (e.g., physical restraints, additional/more invasive chemical restraint).
Interpretation: Olanzapine and diazepam are similarly effective and safe for pediatric ED agitation, but neither is consistently effective, as 40% of participants in each group were not considered adequately sedated.
JC Supervisor: Dr. Krishan Yadav
