Disparities and Variables Associated With Physical Restraint for Acute Agitation in a Nonpsychiatric Emergency Department

Khalid, Zaira; Fana, Michael; Payea, Richelle; Rutledge, Kyle J.; Shah, Bilal; Janssen, Furhut; Ragina, Neli; Zyzanski, Stephen J.

doi:10.4088/pcc.19m02471

Cited by 11 publications

(11 citation statements)

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“…Similar to previous studies, 16,17 we saw that patients with a prior diagnosis of bipolar disorder or a psychotic disorder experience higher rates of physical restraint in our health system. While behavior attributable to underlying mental illness or substance use may be directly contributing to this outcome, the potential role of provider bias against patients with a diagnosis of bipolar disorder or a psychotic disorder should be considered, because existing research suggests that a diagnosis of certain mental health conditions such as schizophrenia can influence medical providers' clinical decision making irrespective of current patient behavior.…”

Section: Discussionsupporting

confidence: 84%

“…14,15 Among agitated ED patients, two factors that have been associated with physical restraint use include a preexisting diagnosis of depression and antipsychotics as a home medication. 16 A recent study found the risk for physical restraint to be higher among Black/African American male patients than among their White/Caucasian counterparts, irrespective of a history of violence. 17 Although a single-center study, it was the first ED-based study specifically designed to examine the role of race in physical restraint use.…”

Section: Introductionmentioning

confidence: 99%

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Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis

Tartak

Brisbon

Wilkie

et al. 2021

Academic Emergency Medicine

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BackgroundResearch regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation.MethodsWe identified all ED patient encounters with a section 12(a) order across a large integrated 11‐hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in‐network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed‐effect logistic regression with random‐intercept model.ResultsWe identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.28 to 1.63), Black/African American race (aOR = 1.22, 95% CI = 1.01 to 1.48), Hispanic ethnicity (aOR = 1.45, 95% CI = 1.22 to 1.73), Medicaid insurance (aOR = 1.21, 95% CI = 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR = 1.51, 95% CI = 1.31 to 1.74). Across all age groups, patients who were 25 to 34 years of age were at highest risk of restraint (aOR = 2.01, 95% CI = 1.69 to 2.39). Patients with a primary care provider within our network (aOR = 0.81, 95% CI = 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness.ConclusionBlack/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis

Tartak

Brisbon

Wilkie

et al. 2021

Academic Emergency Medicine

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Section: Resultsmentioning

confidence: 99%

“…In 7 studies, patient race was determined through the electronic health record. Of these 7, two reported that the patient self-selected their racial categorization, 1 reported this was entered by registration staff, and 4 did not report how race was determined. An ED nurse determined race in 1 study, 1 asked patients to report their race directly via questionnaire, and 1 study did not report how race was determined.…”

Section: Resultsmentioning

confidence: 99%

“…Three of the 10 studies identified Hispanic/Latinx as a race, whereas 5 reported Hispanic/Latinx and not Hispanic/Latinx ethnicity. Two studies categorized race into White or other only . Only 1 study reported data on individuals of Indigenous, Native American, or Native Hawaiian race, and 1 reported on those of multiracial background (but did not specify which races).…”

Section: Resultsmentioning

confidence: 99%

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Racial Disparities in Emergency Department Physical Restraint Use

Eswaran,

Molina,

Hwong

et al. 2023

JAMA Intern Med

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ImportanceRecent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability.ObjectiveTo synthesize existing literature on risk of physical restraint use in adult EDs, specifically in reference to patients of different racial and ethnic backgrounds.Data SourcesA systematic search of PubMed, Embase, Web of Science, and CINAHL was performed from database inception to February 8, 2022.Study SelectionIncluded peer-reviewed studies met 3 criteria: (1) published in English, (2) original human participants research performed in an adult ED, and (3) reported an outcome of physical restraint use by patient race or ethnicity. Studies were excluded if they were conducted outside of the US, or if full text was unavailable.Data Extraction and SynthesisFour independent reviewers (V.E., M.M., D.D., and A.H.) abstracted data from selected articles following Meta-Analysis of Observational Studies in Epidemiology guidelines. A modified Newcastle-Ottawa scale was used to assess quality. A meta-analysis of restraint outcomes among minoritized racial and ethnic groups was performed using a random-effects model in 2022.Main Outcome(s) and Measure(s)Risk of physical restraint use in adult ED patients by racial and ethnic background.ResultsThe search yielded 1597 articles, of which 10 met inclusion criteria (0.63%). These studies represented 2 557 983 patient encounters and 24 030 events of physical restraint (0.94%). In the meta-analysis, Black patients were more likely to be restrained compared with White patients (RR, 1.31; 95% CI, 1.19-1.43) and to all non-Black patients (RR, 1.27; 95% CI, 1.23-1.31). With respect to ethnicity, Hispanic patients were less likely to be restrained compared with non-Hispanic patients (RR, 0.85; 95% CI, 0.81-0.89).Conclusions and RelevancePhysical restraint was uncommon, occurring in less than 1% of encounters, but adult Black patients experienced a significantly higher risk of physical restraint in ED settings compared with other racial groups. Hispanic patients were less likely to be restrained compared with non-Hispanic patients, though this observation may have occurred if Black patients, with a higher risk of restraint, were included in the non-Hispanic group. Further work, including qualitative studies, to explore and address mechanisms of racism at the interpersonal, institutional, and structural levels are needed.

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Disparities and Outcomes of Physical Restraint Use in Hepatic Encephalopathy: A National Inpatient Assessment

Ali,

Goble,

Leventhal

2024

Dig Dis Sci

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Disparities and Variables Associated With Physical Restraint for Acute Agitation in a Nonpsychiatric Emergency Department

Cited by 11 publications

References 0 publications

Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis

Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis

Racial Disparities in Emergency Department Physical Restraint Use

Disparities and Outcomes of Physical Restraint Use in Hepatic Encephalopathy: A National Inpatient Assessment

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