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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

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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.

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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.