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Pharmacologic Restraint Use During Mental Health Visits in Pediatric Emergency Departments

Ashley A Foster1, John J Porter2, Michael C Monuteaux2

  • 1Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.

The Journal of Pediatrics
|March 27, 2021
PubMed

Insights

Pediatric mental health emergency department visits and the use of pharmacologic restraint are increasing. Significant hospital variation in restraint use highlights opportunities to standardize care and reduce its application.

Area of Science:

  • Pediatric Emergency Medicine
  • Child and Adolescent Psychiatry
  • Health Services Research

Background:

  • Emergency departments (EDs) are crucial for pediatric mental health crises.
  • Pharmacologic restraint is a tool used in EDs, but its application in pediatric mental health requires careful examination.
  • Understanding trends and variations in its use is essential for improving patient care.

Purpose of the Study:

  • To analyze the trends in pharmacologic restraint use for pediatric mental health visits in emergency departments.
  • To investigate the variation in pharmacologic restraint use across different children's hospitals.
  • To identify factors associated with the use of pharmacologic restraint in this population.

Main Methods:

  • Retrospective analysis of emergency department visits for mental health diagnoses in patients aged 3-21 years.
  • Examination of data from children's hospital EDs between 2009 and 2019.
  • Calculation of restraint use frequency, trends over time, and hospital-level variation using logistic regression.

Main Results:

  • Over 389,000 mental health ED visits were identified, with 3.5% involving pharmacologic restraint.
  • Visits with pharmacologic restraint increased by 370%, outpacing the 268% rise in overall mental health visits.
  • Significant hospital variation in restraint use (1.6%-11.8%) was observed, with factors like age, sex, race, insurance, and admission status associated with its use.

Conclusions:

  • Both pediatric mental health ED visits and the use of pharmacologic restraint are increasing.
  • The threefold increase in pharmacologic restraint use necessitates attention.
  • Significant inter-hospital variation indicates a need for standardized care protocols to reduce restraint use.
Abstract

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