Patient Race and Preferred Language Influence the Use of Physical Restraints on Nonintubated Intensive Care Unit...

Rationale: Physical limb restraints are commonly used in intensive care units (ICUs) to protect patients and staff but are associated with increased morbidity and disparities in care, particularly in intubated patients. Whether disparities in restraint use persist for nonintubated patients remains less clear. Objectives: We sought to identify whether patient race, ethnicity, and preferred language are associated with restraint use in nonintubated patients across multiple ICUs in a large U.S. hospital system. Methods: We performed a retrospective cohort study using electronic health record data across five ICUs within the University of California, San Francisco, from 2013 to 2022. We included adults who were 18 years of age and older. We excluded patients who received mechanical ventilation during their ICU stay. Our primary independent variables were primary language, race, and ethnicity. The outcome of interest was restraint use, defined as at least one restraint order placed during the patient's ICU stay. We modeled any restraint use using a multivariable logistic regression adjusted for sociodemographic and clinical covariates and explored interactions of our primary exposures using sensitivity analyses and Wald testing. Results: Across 22,259 unique ICU admissions, we identified 11,676 nonintubated patients. Of these, 2,411 (20%) received an order for physical restraints. In a multivariable regression model, compared with English, Chinese (all dialects) (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.31-1.87) and a language other than Chinese, English, or Spanish (OR, 1.60; 95% CI, 1.36-1.89) were associated with increased use of restraints. Patients identifying as Black or African American were also more likely to be restrained at least once during the encounter (OR, 1.51; 95% CI, 1.27-1.79) compared with non-Hispanic White patients. Conclusions: Patients preferring Chinese or any language other than English or Spanish and those who identify as Black are more likely to be restrained in the ICU when not intubated. Interventions to minimize the use of unnecessary physical restraints could improve an inequity known to be associated with downstream harms.