Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.
Acad Emerg Med. 2024 Jan;31(1):6-17. doi: 10.1111/acem.14792. Epub 2023 Sep 12.
Recent reports have identified associations between patient race and ethnicity and use of physical restraint while receiving care in the emergency department (ED). However, no study has assessed this relationship in hospitals primarily treating patients of color and underserved populations. The primary objective of this study was to evaluate the association between race/ethnicity and the use of restraints in an ED population at a minority-serving, safety-net institution.
For this cross-sectional study, chart review identified all adult patients presenting to the Boston Medical Center ED between January 2018 and April 2021. Generalized estimating equation logistic regression modeling was conducted to evaluate associations between race and use of restraints.
Of 348,384 ED visits (22.9% White, 46.7% Black, 23.1% Hispanic), 1852 (0.5%) had an associated physical restraint order. Multivariable models showed significant interactions (p = 0.02) between race/ethnicity, behavioral health diagnosis, and sex on the primary outcome of physical restraint. Stratified analysis revealed that among patients with no behavioral health diagnoses, Black (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.34-0.72, p = 0.0003) and Hispanic (OR 0.35, 95% CI 0.20-0.63, p = 0.0004) patients had lower odds of restraint than White patients. Among female patients with a mental health and/or substance use disorder diagnosis, Black (OR 1.95, 95% CI 1.49-2.54, p < 0.0001) and Hispanic (OR 2.13, 95% CI 1.49-3.03, p < 0.0001) patients had higher odds of restraint than White patients. Similar trends were observed for Black male patients (OR 1.60, 95% CI 1.34-1.91, p < 0.0001) but not for Hispanic male patients (OR 0.96, 95% CI 0.73-1.26, p = 0.77) with behavioral health diagnoses who had similar odds of restraint to White patients. Additional factors associated with physical restraint include younger age, public or lack of insurance, and ED visits during the pandemic.
Racial disparities exist in restraint utilization at this minority-serving safety-net hospital; however, these disparities are modified by sex and by behavioral health diagnoses. The reasons for these disparities may be multifactorial and warrant further investigation.
最近的报告表明，患者的种族和民族与在急诊科（ED）接受护理时使用身体约束之间存在关联。然而，尚无研究评估在主要治疗有色人种和服务不足人群的医院中这种关系。本研究的主要目的是评估在少数族裔服务的安全网机构的 ED 人群中种族/民族与使用约束之间的关联。
本横断面研究通过图表审查确定了 2018 年 1 月至 2021 年 4 月期间在波士顿医疗中心 ED 就诊的所有成年患者。采用广义估计方程逻辑回归模型评估种族与使用约束之间的关联。
在 348384 例 ED 就诊中（白人占 22.9%，黑人占 46.7%，西班牙裔占 23.1%），有 1852 例（0.5%）存在相关的物理约束医嘱。多变量模型显示种族/民族、行为健康诊断和性别之间存在显著的交互作用（p=0.02），这是主要结局（身体约束）的影响因素。分层分析显示，在没有行为健康诊断的患者中，黑人（比值比 [OR] 0.50，95%置信区间 [CI] 0.34-0.72，p=0.0003）和西班牙裔（OR 0.35，95% CI 0.20-0.63，p=0.0004）患者的约束可能性低于白人患者。在有心理健康和/或物质使用障碍诊断的女性患者中，黑人（OR 1.95，95% CI 1.49-2.54，p<0.0001）和西班牙裔（OR 2.13，95% CI 1.49-3.03，p<0.0001）患者的约束可能性高于白人患者。在有行为健康诊断的黑人男性患者中也观察到类似的趋势（OR 1.60，95% CI 1.34-1.91，p<0.0001），但在有行为健康诊断的西班牙裔男性患者中未观察到这种趋势（OR 0.96，95% CI 0.73-1.26，p=0.77），他们与白人患者的约束可能性相似。与身体约束相关的其他因素包括年龄较小、公共保险或缺乏保险，以及大流行期间的 ED 就诊。
在这家少数族裔服务的安全网医院中，在使用约束方面存在种族差异；然而，这些差异受到性别和行为健康诊断的影响。这些差异的原因可能是多方面的，需要进一步调查。
