Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals

Abstract

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.

Antidepressant Use and Risk of Manic Episodes in Children and Adolescents With Unipolar Depression

“…Additionally, we found the use of antiepileptics to be associated with mania/hypomania. The association may indicate that the patients had shown signs of mood instability shortly after the time of diagnosis . Antidepressant treatment was unrelated to the risk of mania/hypomania, suggesting that these other characteristics are more relevant when evaluating which patients may have an increased risk of switching from unipolar depression to mania.…”

“…The association may indicate that the patients had shown signs of mood instability shortly after the time of diagnosis. 49 Antidepressant treatment was unrelated to the risk of mania/hypomania, suggesting that these other characteristics are more relevant when evaluating which patients may have an increased risk of switching from unipolar depression to mania. Our model using administrative information had a moderate predictive ability, suggesting it is possible to identify patients at high risk for mania/hypomania with a prognostic clinical prediction model.…”

Rethinking restraint use during pediatric mental health hospitalizations

“…In this issue of Journal of Hospital Medicine , Wolf et al 1 analyzes variation in pharmacologic restraint use during pediatric mental health hospitalizations across 49 children's hospitals. Using claims data from the Pediatric Hospital Information System database, the use of pharmacologic restraints varied widely, ranging from 6 to 282 days with pharmacologic restraint use per 1000 mental health bed days.…”