Gupta Ishaan, Nelson-Greenberg Ilana, Wright Scott Mitchell, Harris Ché Matthew
Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD.
Mayo Clin Proc Innov Qual Outcomes. 2024 Jan 4;8(1):37-44. doi: 10.1016/j.mayocpiqo.2023.12.003. eCollection 2024 Feb.
To determine the change in rates of physical restraint (PR) use and associated outcomes among hospitalized adults.
Using national inpatient sample databases, we analyzed years 2011-2014 and 2016-2019 to determine trends of PR usage. We also compared the years 2011-2012 and 2018-2019 to investigate rates of PR use, in-hospital mortality, length of stay, and total hospital charges.
There were 242,994,110 hospitalizations during the study period. 1,538,791 (0.63%) had coding to signify PRs, compared with 241,455,319 (99.3%), which did not. From 2011 to 2014, there was a significant increase in PR use (trend<.01) and a nonsignificant increase in PR rates from 2016-2019 (trend=.07). Over time, PR use increased (2011-2012: 0.52% vs 2018-2019: 0.73%; <.01). Patients with PRs reported a higher adjusted odds for in-hospital mortality in 2011-2012 (adjusted odds ratio [aOR], 3.9; 95% CI, 3.7-4.2; <.01) and 2018-2019 (aOR, 3.5; 95% CI, 3.4-3.7; <.01). Length of stay was prolonged for patients with PRs in 2011-2012 (adjusted mean difference [aMD], 4.3 days; 95% CI, 4.1-4.5; <.01) and even longer in 2018-2019 (aMD, 5.8 days; 95% CI, 5.6-6.0; <.01). Total hospital charges were higher for patients with PRs in 2011-2012 (aMD, +$55,003; 95% CI, $49,309-$60,679; <.01). Following adjustment for inflation, total charges remained higher for patients with PRs compared with those without PRs in 2018-2019 (aMD, +$70,018; 95% CI, $65,355-$74,680; <.01).
Overall, PR rates did not decrease across the study period, suggesting that messaging and promulgating best practice guidelines have yet to translate into a substantive change in practice patterns.
确定住院成人使用身体约束（PR）的比率变化及相关结果。
利用国家住院患者样本数据库，我们分析了2011 - 2014年以及2016 - 2019年的数据，以确定PR使用趋势。我们还比较了2011 - 2012年和2018 - 2019年的数据，以研究PR使用率、住院死亡率、住院时间以及总住院费用。
研究期间共有242,994,110例住院病例。其中1,538,791例（0.63%）有编码显示使用了PR，未使用PR的有241,455,319例（99.3%）。从2011年到2014年，PR使用率显著上升（趋势<0.01），2016 - 2019年PR比率有不显著的上升（趋势 = 0.07）。随着时间推移，PR使用率上升（2011 - 2012年：0.52% 对比2018 - 2019年：0.73%；<0.01）。2011 - 2012年及2018 - 2019年，使用PR的患者住院死亡率调整后优势比更高（2011 - 2012年：调整后优势比[aOR]为3.9；95%置信区间[CI]，3.7 - 4.2；<0.01；2018 - 2019年：aOR为3.5；95% CI，3.4 - 3.7；<0.01）。2011 - 2012年使用PR的患者住院时间延长（调整后平均差异[aMD]为4.3天；95% CI，4.1 - 4.5；<0.01），2018 - 2019年更长（aMD为5.8天；95% CI，5.6 - 6.0；<0.01）。2011 - 2012年使用PR的患者总住院费用更高（aMD为 +$55,003；95% CI，$49,309 - $60,679；<0.01）。在对通货膨胀进行调整后，2018 - 2019年使用PR的患者与未使用PR的患者相比，总费用仍然更高（aMD为 +$70,018；95% CI，$65,355 - $74,680；<0.01）。
总体而言，在整个研究期间PR比率并未下降，这表明相关信息传递及最佳实践指南的推广尚未转化为实际模式的实质性改变。
