Characteristics of Patients Associated With Restraint Use at a Midwest Children’s Hospital

Abstract

BACKGROUND AND OBJECTIVES Restraint use is associated with negative mental health outcomes, injury risk, and known disparities in use. Improved understanding of restraint use among hospitalized children is critical given the increased frequency of hospitalized children with complex and/or acute mental health needs. Our objective is to describe the demographic and clinical features of children associated with mechanical restraint. METHODS In a single-center retrospective cohort study of patients hospitalized from 2017 to 2021, restraint encounters were identified from electronic health records. Odds of restraint was modeled as a function of patient demographic and clinical characteristics, as well as hospitalization characteristics using logistic regression modeling adjusted for clustering of hospitalizations within patients and for varying lengths of stay. RESULTS Among 29 808 children (46 302 encounters), 225 patients (275 encounters) had associated restraint use. In regression modeling, odds of restraint were higher with restraint at the preceding hospitalization (adjusted odds ratio [aOR] 8.6, 95% confidence interval [CI] 4.8–15.5), diagnosis of MH conditions such as psychotic disorders (aOR 5.4, 95% CI 2.7–10.4) and disruptive disorders (aOR 4.7, 95% CI 2.8–7.8), male sex (aOR 1.9, 95% CI 1.5–2.5), and Black race (aOR relative to White patients 1.9, 95% CI 1.4–2.6). CONCLUSIONS Our results suggest racial inequities in restraint use for hospitalized children. This finding mirrors inequities in restraint use in the emergency department and adult settings. Understanding the behavioral needs of such patients may help in reducing restraint use and improving health equity.