Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Menominee Indian Tribe of Wisconsin, Keshena, WI, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA.
Ann Emerg Med. 2024 Feb;83(2):91-99. doi: 10.1016/j.annemergmed.2023.08.009. Epub 2023 Sep 19.
To determine what patient characteristics were associated with the application of physical restraints in our emergency department (ED).
This was a retrospective analysis of encounters in the ED of an urban, Level I academic trauma center. We included ED encounters of adult patients (aged ≥18 years) during a 5-year period starting in 2017. We evaluated the independent association of restraint application during an encounter using a generalized estimating equation model.
There were 464,031 ED encounters during the time period from 162,244 unique patients, including 34,798 (7.5%) with restraint application, comprising 18,166 unique patients. Several variables were associated with an increased likelihood of restraint use during an encounter. The variable with the highest odds ratio was intoxication with drugs or alcohol (adjusted odds ratio [aOR] 8.29; 95% confidence interval (CI) 7.94 to 8.65). American Indian race was associated with increased odds of restraint application (aOR 1.42; 95% CI 1.31 to 1.54) compared to the reference value of White race. Black race (aOR 0.58; 95% CI 0.55 to 0.61) and Hispanic ethnicity (aOR 0.42; 95% CI 0.37 to 0.48) were associated with lower odds of restraint application.
Drug and alcohol intoxication were most closely associated with restraint. Encounters in which the patient was American Indian had higher odds of restraint, but this study does not replicate prior findings regarding other racial disparities in restraint.
确定哪些患者特征与我们急诊科（ED）中使用身体约束有关。
这是对城市一级学术创伤中心 ED 中患者就诊的回顾性分析。我们纳入了 2017 年开始的 5 年期间成年患者（年龄≥18 岁）的 ED 就诊。我们使用广义估计方程模型评估了就诊期间使用约束的独立关联。
在 162244 名独特患者的 464031 次 ED 就诊中，有 34798 次（7.5%）应用了约束，包括 18166 名独特患者。有几个变量与就诊期间使用约束的可能性增加有关。比值比最高的变量是药物或酒精中毒（调整比值比 [aOR] 8.29；95%置信区间 [CI] 7.94 至 8.65）。与白人种族相比，美国印第安人种族与约束应用的几率增加相关（aOR 1.42；95% CI 1.31 至 1.54）。黑人种族（aOR 0.58；95% CI 0.55 至 0.61）和西班牙裔（aOR 0.42；95% CI 0.37 至 0.48）与约束应用的几率降低相关。
药物和酒精中毒与约束最密切相关。就诊时患者为美国印第安人的，约束的几率更高，但本研究并未复制先前关于约束中其他种族差异的发现。
