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Physical Restraints in Critically Ill Children: A Multicenter Longitudinal Point Prevalence Study
Ryo Ikebe1, Atsushi Kawaguchi1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18, Tatsuya Kawasaki5
1Department of Nursing, Osaka Women's and Children's Hospital, Osaka, Japan.
Insights
Physical restraint use was high in pediatric intensive care units (PICUs), affecting over half of critically ill children. Factors like patient age, unit size, and lack of policy influenced restraint frequency.
Area of Science:
- Pediatric critical care medicine
- Patient safety and quality improvement
- Clinical research methodology
Background:
- Physical restraints are used in pediatric intensive care units (PICUs) for critically ill or injured children.
- Understanding the prevalence and associated factors of physical restraint use is crucial for improving patient care and safety.
Purpose of the Study:
- To investigate the prevalence of physical restraint use in critically ill or injured children admitted to PICUs.
- To identify factors associated with the use of physical restraints in this vulnerable population.
Main Methods:
- A multicenter, longitudinal point prevalence study was conducted across 26 PICUs in Japan.
- Data were collected on three dates in 2019, screening 398 children aged 1 month to 10 years.
- Prevalence, demographic characteristics, and details of physical restraint use were recorded.
Main Results:
- The prevalence of physical restraint use was 53%, with wrist restraint bands being the most common type.
- Children aged 1-2 years had higher odds of restraint use (adjusted odds ratio 2.3).
- Units without a practice policy or those with over 10 beds showed increased likelihood of restraint use.
Conclusions:
- Physical restraint use is prevalent and varies significantly among PICUs.
- Patient age, unit size, and the presence of a practice policy are associated with physical restraint frequency.
- Findings highlight the need for standardized protocols to optimize physical restraint management in pediatric critical care.
Objectives:
We elucidate to investigate the prevalence of and factors associated with the use of physical restraints among critically ill or injured children in PICUs.
Design:
This was a multicenter, longitudinal point prevalence study.
Setting:
We included 26 PICUs in Japan.
Patients:
Included children were 1 month to 10 years old. We screened all admitted patients in the PICUs on three study dates (in March, June, and September 2019).
Intervention:
None.
Measurements And Main Results:
We collected prevalence and demographic characteristics of critically ill or injured children with physical restraints, as well as details of physical restraints, including indications and treatments provided. A total of 398 children were screened in the participating PICUs on the three data collection dates. The prevalence of children with physical restraints was 53% (211/398). Wrist restraint bands were the most frequently used means (55%, 117/211) for potential contingent events. The adjusted odds of using physical restraint in patients 1-2 years old was 2.3 (95% CI, 1.3-4.0) compared with children less than 1 year old. When looking at the individual hospital effect, units without a prespecified practice policy for physical restraints management or those with more than 10 beds were more likely to use physical restraints.
Conclusions:
The prevalence of physical restraints in critically ill or injured children was high, and significant variation was observed among PICUs. Our study findings suggested that patient age, unit size, and practice policy of physical restraint could be associated with more frequent use of physical restraints.
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