A Nomogram for Predicting Physical Restraint of Patients in Intensive Care Unit

Abstract

Background. Despite its ethical implications, physical restraint (PR) is widely used in the intensive care unit (ICU) to guarantee the safety of patients. This study investigated the frequency and risk factors of PR use for patients in the ICU to establish a predictive nomogram. Methods. Clinical parameters of patients admitted to the ICU of Jiangsu Province Hospital from January 2021 to July 2021 were retrospectively collected. Independent risk factors of PR were analyzed by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram. Model performance was validated using the concordance-index (C-index) and calibration curves. Results. The rate of PR use was 46.32% (233/503 patients). Age (B = 0.036, odds ratio [OR]: 1.037, 95% confidence interval [CI]: 1.022–1.052, $P<0.001$ ), consciousness disorder (B = 0.770, OR: 2.159, 95% CI: 1.216–3.832, $P=0.009$ ), coma (B = −1.666, OR: 0.189, 95% CI: 0.101–0.353, $P<0.001$ ), passive activity (B = 1.014, OR: 2.756, 95% CI: 1.644–4.618, $P<0.001$ ), delirium (B = 0.993, OR: 2.699, 95% CI: 1.097–6.642, $P=0.031$ ), −3 < Richmond Agitation Sedation Scale (RASS) score <2 (B = 0.698, OR: 2.009, 95% CI: 1.026–3.935, $P=0.042$ ), RASS score ≥2 (B = 1.253, OR: 3.499, 95% CI: 1.126–10.875, $P=0.030$ ), and mechanical ventilation (B = 1.696, OR: 5.455, 95% CI: 2.804–10.611, $P<0.001$ ) were identified as independent risk factors for PR in the ICU ( $P<0.05$ ) and included in the nomogram. The C-index was 0.830, and the calibration curve indicated good discriminatory ability and accuracy (mean absolute error: 0.026). Conclusion. The prediction nomogram model of PR in ICU was established based on age, mobility, delirium, consciousness, RASS score, and mechanical ventilation. It showed good discrimination and accuracy. This nomogram may predict the probability of PR use in the ICU and guide nurses in developing precise interventions to reduce the rate of PR.