Dorfman David H, Kastner Beth
*Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA; †Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.
Pediatr Emerg Care. 2004 Mar;20(3):151-156. doi: 10.1097/01.pec.0000117921.65522.fd.
To identify current practice and staff education regarding the use of restraint in emergency departments for children undergoing psychiatric evaluations and to compare restraint practice and education in emergency medicine residencies (EMRs) and pediatric emergency medicine fellowships (PEMFs).
A self-administered survey regarding staff and resident education and the use of restraint for emergency pediatric patients undergoing psychiatric evaluation was mailed to the directors of EMRs and PEMFs. Main outcome measures included frequency of restraint use, staff trained in restraint use, favored positions for physical restraint, and agents regularly used for chemical restraint.
Forty-one percent (48/118) of EMRs and 66% (33/50) of PEMFs completed the survey. The great majority of both EMRs and PEMFs report use of physical and chemical restraint in 5% or less of pediatric psychiatric patients. Forty of 47 EMRs and 29 of 32 PEMFs have formal policies on physical restraint use. Far fewer programs have formal policies for chemical restraint (13/33 EMRs and 5/28 PEMFs). A large percentage of both EMRs and PEMFs do not teach their trainees about the application of restraints (EMR = 52%, PEMF = 82%) or the appropriate situations in which to use restraint (EMR = 35%, PEMF = 64%). However, EMRs were more likely than PEMFs to teach about both appropriate restraint application and appropriate situations for their use (RR = 2.6, 1.2-5.8 and RR = 1.8, 1.1-2.9, respectively). The supine position was the position favored by both groups for physical restraint. Therapeutic holding was infrequently used, mostly for younger children. Seventy-two percent of EMRs and 85% of PEMFs used chemical restraint in children. Benzodiazepines and butyrophenones were the most commonly used agents. However, butyrophenones were often misclassified as phenothiazines by both EMRs and PEMFs.
Restraint, both physical and chemical, is a widely, but uncommonly used, intervention for pediatric psychiatric patients in emergency departments. Many EMRs and PEMFs do not teach residents about restraint.
确定急诊科对接受精神科评估的儿童使用约束措施的当前做法及员工培训情况，并比较急诊医学住院医师培训项目（EMRs）和儿科急诊医学 fellowship 项目（PEMFs）中的约束措施使用情况及培训情况。
一份关于员工及住院医师培训以及对接受精神科评估的急诊儿科患者使用约束措施的自填式调查问卷被邮寄给了 EMRs 和 PEMFs 的主任。主要观察指标包括约束措施的使用频率、接受约束措施使用培训的员工、身体约束的首选姿势以及常用于化学约束的药物。
41%（48/118）的 EMRs 和 66%（33/50）的 PEMFs 完成了调查。绝大多数 EMRs 和 PEMFs 报告称，在 5%或更少的儿科精神科患者中使用了身体和化学约束措施。47 个 EMRs 中的 40 个以及 32 个 PEMFs 中的 29 个有关于身体约束措施使用的正式政策。制定化学约束措施正式政策的项目要少得多（EMRs 中有 13/33，PEMFs 中有 5/28）。很大比例的 EMRs 和 PEMFs 都没有对其学员进行约束措施应用（EMRs = 52%，PEMFs = 82%）或使用约束措施的适当情况（EMRs = 35%，PEMFs = 64%）方面的教学。然而，EMRs 比 PEMFs 更有可能对学员进行适当约束措施应用和使用约束措施的适当情况方面的教学（相对风险分别为 2.6，1.2 - 5.8 和 1.8，1.1 - 2.9）。仰卧位是两组在身体约束时都青睐的姿势。治疗性拥抱很少使用，主要用于年幼儿童。72%的 EMRs 和 85%的 PEMFs 在儿童中使用化学约束措施。苯二氮䓬类药物和丁酰苯类药物是最常用的药物。然而，EMRs 和 PEMFs 常常将丁酰苯类药物误分类为吩噻嗪类药物。
身体和化学约束措施是急诊科对儿科精神科患者广泛但不常用的干预措施。许多 EMRs 和 PEMFs 没有对住院医师进行约束措施方面的教学。
