Structural and Clinical Factors Associated with Physical Restraint Use in a Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Child Psychiatry
• Health Services Research

Background:

• Physical restraint is a controversial intervention used in pediatric emergency departments (EDs) for behavioral health concerns.
• Understanding factors contributing to restraint use is crucial for developing safer care practices.

Purpose of the Study:

• To investigate the association between structural factors (child protective services involvement, police/EMS transport) and clinical factors (autism diagnosis) with physical restraint use in pediatric ED encounters.
• To identify demographic disparities in physical restraint use.

Main Methods:

• Retrospective cohort study of pediatric ED encounters for behavioral health concerns (January 2021-October 2023).
• Multivariable logistic regression analysis to assess associations between predictors and physical restraint use, adjusted for demographics.

Main Results:

• Physical restraints were used in 1.97% of 6288 encounters.
• Autism diagnosis (aOR=7.25), police/EMS transport (aOR=3.07), child protective services involvement (aOR=1.91), and Black race (aOR=1.78) were significantly associated with increased restraint use.
• Children with autism were over 7 times more likely to be restrained.

Conclusions:

• Structural and child-level factors, including autism diagnosis, child protective services involvement, transport mode, and race, are independently linked to increased physical restraint use.
• These findings underscore the need for multifactorial approaches to mitigate physical restraint in pediatric emergency behavioral health care.