Restraint use for psychiatric patients in the pediatric emergency department

Background: Restraint of children and adolescents with psychiatric problems has generated controversy. Restraint may be defined as methods used to restrict movement or normal access to one's body. Published data to guide restraint practice are limited. Objective: To examine frequency of restraint use and patient demographics and chief complaints associated with restraint use in our pediatric emergency department. Methods: We retrospectively reviewed the pediatric emergency department records of children (age <18 years) who underwent emergency psychiatric evaluation in an urban general hospital from January 2001 to December 2002. Factors associated with restraint use were determined using multivariate logistic regression. Results: Data were available for 1125 (82%) of 1371 patients who underwent emergency psychiatric evaluation; 76 (6.8%) of 1125 patients were restrained: 37 physical, 19 with medication, and 20 both. Study patients were mean age 13.1 years, 50% girls, 54% blacks, 19% Latinos, and 18% whites; 80% had public insurance. Boys were restrained more often than girls (8.7% vs. 5.2%, P = 0.02). Age, insurance, and race were not associated with restraint use. Patients admitted for inpatient psychiatric care were restrained more frequently than those discharged home (9.9% vs. 3.9%, P < 0.001). In multivariate logistic regression, sex was not associated with restraint use. Restraint use was associated with chief complaints of visual hallucinations (odds ratio, 5.29), out-of-control behavior (odds ratio, 4.65), hyperactivity (odds ratio, 2.26), and admission to a psychiatric facility (odds ratio, 2.40). Conclusions: Approximately 1 in 15 children undergoing psychiatric evaluation were restrained. This is the first study to elucidate correlates of restraint practice in the pediatric emergency department. Further studies examining indications for restraint and comparing methods of restraint are needed.