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Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals
Ryan M Wolf1, Matthew Hall2, Derek J Williams1
1Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Children
Area of Science:
- Pediatric mental health care
- Pharmacology in child psychiatry
Background:
- Children's hospitals increasingly admit youth in mental health crises awaiting psychiatric placement.
- Agitation during hospitalization may necessitate pharmacologic restraint.
Purpose of the Study:
- Determine hospital-level incidence and variation of pharmacologic restraint use.
- Analyze restraint use among children admitted for mental health conditions.
Main Methods:
- Utilized Pediatric Health Information System data (2018-2020).
- Calculated parenteral pharmacologic restraint rates per 1000 mental health bed days.
- Employed cluster analysis to group hospitals by restraint use and drug class.
Main Results:
- 12.6% of 29,834 encounters involved pharmacologic restraint.
- Adjusted hospital rates varied widely (35-389 per 1000 bed days).
- Three hospitals emerged as high utilizers across all drug classes.
Conclusions:
- Significant variation exists in pediatric pharmacologic restraint rates.
- A 10-fold difference was observed between highest and lowest utilizing hospitals.
- High-utilizing hospitals consistently used multiple drug classes for restraint.
Background:
Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use.
Objective:
To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals.
Design, Setting, And Participants:
We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared.
Results:
Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis.
Conclusions:
Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.
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