PEAChY-O and PEAChY-M Studies

Pharmacological Emergency management of Agitation in Children and Young people (PEAChY)

Acute severe behavioural disturbance (ASBD) is any behaviour, including agitation, violence, self harm or delirium. This behaviour results in a risk of harm to the person experiencing it, to staff and to others and it requires medical intervention to prevent and/or reduce the risk of this harm. Children and adolescents with ASBD are presenting more frequently to Australian EDs over the past decade. These presentations pose a significant physical and psychological risk to the patient and those involved in caring for them within the ED.

Presentations of ASBD are managed in a step-wise manner. Non-pharmacological strategies are employed first if appropriate. If these strategies fail and the child still poses a significant risk to themselves or others, medication will be provided to assist the child to gain control over their behaviour. This usually involves offering oral medication. In a small percentage of children who are extremely agitated, parenteral medication will be required.

There is limited evidence to guide which are the most efficacious medications (oral and parenteral) for the management of ASBD in the paediatric population. Current practice has been extrapolated from the adult ASBD literature.

We therefore propose to undertake the PEAChY study to determine which medication is the most effective for the management of this condition.

Two separate but linked studies will be undertaken. PEAChY-O (Oral) will assess the effectiveness of oral medications for de-escalating ASBD and PEAChY-M (IM) will assess the effectiveness of intramuscular medications.

As well as determining which medication is the most effective, we will monitor the safety and side effect profiles of each medication.

Study design

Two multi centre, parallel group, single-blinded, randomised controlled trials will be undertaken.

Active

Mental Health

Elyssia Bourke (Murdoch Children’s Research Institute)
Simon Craig (Monash Health)
Andrew Davidson (Royal Children’s Hospital)
Jonathan Knott (Royal Melbourne Hospital; University of Melbourne)
Kate Lee (Murdoch Children’s Research Institute)
Franz Babl (Royal Children’s Hospital; Murdoch Children’s Research Institute)
Michael Gordon (University of Melbourne)

Study Coordinator

Kate Klein (Royal Children’s Hospital; Murdoch Children’s Research Institute)

Timeframe

2020 – 2025

Funding

Medical Research Futures Fund (MRFF) Million Minds Grant
Emergency Medicine Foundation (QLD)


  • Royal Children’s Hospital, Melbourne (PIs Elyssia Bourke & Franz Babl)
  • Monash Children’s Hospital, Melbourne (PI Simon Craig)
  • Queensland Children’s Hospital (PI Deborah Shellshear )
  • Perth Children’s Hospital (PI Meredith Borland)
  • Women’s and Children’s Hospital Adelaide (PI Amit Kochar)
  • The Children’s Hospital at Westmead (PI Shefali Jani)
  • Gold Coast University Hospital (PI Shane George)
  • Ballarat Base Hospital (PI Elyssia Bourke)
  • Sunshine Hospital Western Health (PI Doris Tham)
  • Sunshine Coast University Hospital (PI Kent Perkins)

Sample

Oral Medication – 694 total participants aged <18 years of age requiring oral medication for ASBD
IM medication – 556 total participants aged < 18 years of age with ASBD requiring IM medication for ASBD

Clinical trials registration

Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12621001236886

Contact

elyssia.bourke@mcri.edu.au
franz.babl@rch.org.au

Publications to date

Bourke E, Douglas N, Nehme Z, Knott J, Craig SS, Babl FE, the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network. Qualitative exploration of health care professionals’ experiences caring for young people with acute severe behaviorial disturbance in the acute care setting. JACEP Open. 6:100030.

Bourke EM, Douglas N, Wilson CL, Anderson D, Nehme Z, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review. Ann Emerg Med. 2023 Jun 30:S0196-0644(23)00355-4.
doi: 10.1016/j.annemergmed.2023.04.028. Epub ahead of print. PMID: 37389492. [Link]

Bourke EM, Borland ML, Kochar A, George S, Shellshear D, Jani S, Perkins K, Tham D, Gordon MS, Klein K, Prakash C, Lee K, Davidson A, Knott JC, Craig S, Babl FE; Paediatric research in Emergency Departments International Collaborative (PREDICT). Pharmacological emergency management of agitation in children and young people: protocol for a randomised controlled trial of oral medication (PEAChY-O). BMJ Open. 2023 Mar 30;13(3):e067433. doi: 10.1136/bmjopen-2022-067433. PMID: 36997250; PMCID: PMC10069548. [Link]

Bourke EM, Say DF, Carison A, Hill A, Craig S, Hiscock H, Babl FE, O’Donnell SM. Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. J Paediatr Child Health. 2021 May 8. doi: 10.1111/jpc.15535. Epub ahead of print. PMID: 33963626. [Link]

Bourke EM, Borland ML, Kochar A, George S, Shellshear D, Jani S, Perkins K, Tham D, Gordon MS, Klein K, Chidambaram P, Lee K, Davidson A, Knott JC, Craig S, Babl FE. Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M). BMJ Open. 2023;13:e067436. [Link]