Association between patient race and emergency department physical restraint use in a statewide hospital system

J David Gatz; Benoit Stryckman; Laurence S Magder; Sanyukta Deshmukh; Mark Sutherland; Daniel B Gingold

doi:10.1016/j.ajem.2024.10.033

Association between patient race and emergency department physical restraint use in a statewide hospital system

Am J Emerg Med. 2024 Oct 24:87:57-62. doi: 10.1016/j.ajem.2024.10.033. Online ahead of print.

Authors

J David Gatz¹, Benoit Stryckman¹, Laurence S Magder², Sanyukta Deshmukh³, Mark Sutherland¹, Daniel B Gingold⁴

Affiliations

¹ University of Maryland School of Medicine, Department of Emergency Medicine, USA.
² University of Maryland School of Medicine, Department of Epidemiology and Public Health, USA.
³ University of Maryland School of Medicine, USA.
⁴ University of Maryland School of Medicine, Department of Emergency Medicine, USA. Electronic address: dgingold@som.umaryland.edu.

PMID: 39500261
DOI: 10.1016/j.ajem.2024.10.033

Abstract

Objective: To measure the association between patient race and physical restraint use in the ED.

Methods: Adult patients presenting to eight rural, suburban, and urban EDs in a mid-Atlantic statewide hospital system ED between January 1, 2019 and June 30, 2022 were included. Those arriving already restrained, transported from detention centers, or who left before services were provided were excluded. Multivariable logistic regression measured the association of physical restraint use with patient race, adjusting for age, sex, weight, height, mode of arrival, history of violent behavior, comorbidities, ESI acuity level, homelessness, and site.

Results: Of 896,527 patient encounters included in the analysis, 3459 (0.39 %) had a physical restraint order. The study population was 48.7 % non-Hispanic White and 43.7 % non-Hispanic Black. Black patients had higher adjusted odds of being restrained relative to White patients (OR 1.26, 95 % CI 1.15-1.37). Other key variables associated with physical restraint use were an ESI level of 1 vs 3+ (OR 13.15, 95 % CI 11.49-15.04), arrival by law enforcement (8.39, 95 % CI 7.47-9.43), and arrival by EMS (5.36, 95 % CI 4.93-5.83 Among those who were restrained, the hazard of restraint was higher among Black compared to White patients in the first hour after ED arrival (adjusted hazard ratio 1.14, 95 % CI 1.01-1.30).

Conclusion: Black patients were more likely to be physically restrained compared to White patients, though the magnitude of this association was small compared to that of other clinical risk factors. Future work should evaluate if these findings are driven by differences in patient characteristics or clinician decision-making to best inform interventions to reduce this disparity.

Keywords: Agitated patient; Emergency psychiatry; Physical restraint; Racial health disparities.