Ali Yasmin O, Goble Spencer R, Leventhal Thomas M
Department of Medicine, Hennepin Healthcare, 730 South 8th Street, Minneapolis, MN, 55415, USA.
Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, MMC 36, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
Dig Dis Sci. 2025 Jan;70(1):146-153. doi: 10.1007/s10620-024-08758-2. Epub 2024 Nov 24.
Physical restraints may be utilized in patients with hepatic encephalopathy with the intention to ensure patient safety.
Determine if racial and socioeconomic disparities exist in restraint use for patients with hepatic encephalopathy and determine clinical efficacy of restraints in hepatic encephalopathy.
We performed a cross-sectional retrospective study of hospitalizations for hepatic encephalopathy from 2016 to 2021 using the National Inpatient Sample. Patient race and income were assessed for associations with restraint use and restraints themselves were then assessed for associations with clinical outcomes including mortality. Separate analyses were performed for hospitalizations with and without invasive cares defined as the presence of ICD-10 codes for mechanical ventilation, gastric tube placement and/or central venous catheter placement.
Restraint use was documented in 2.4% of 228,430 hospitalizations. In hospitalizations without defined invasive cares, restraint use was increased in Black patients compared to White patients (aOR = 1.57, 95% CI 1.24-1.98, p < 0.001) while lower income was not independently associated with restraint use (1st vs. 4th quartile national income aOR = 0.98, p = 0.895). In hospitalizations that did not involve other defined invasive cares, physical restraint use was associated with higher mortality (aOR = 1.71, 95% CI 1.20-2.43, p = 0.003), whereas in hospitalizations where invasive cares were employed, physical restraint use was associated with reduced mortality (aOR = 0.55, 95% CI 0.40-0.77, p < 0.001).
Careful consideration of the necessity of restraints in hepatic encephalopathy hospitalizations without other invasive cares appears warranted as social disparities in restraint use and increased mortality were both found in this group.
对于肝性脑病患者，可能会使用身体约束措施以确保患者安全。
确定肝性脑病患者在约束使用方面是否存在种族和社会经济差异，并确定约束措施在肝性脑病中的临床疗效。
我们使用国家住院样本对2016年至2021年期间因肝性脑病住院的患者进行了横断面回顾性研究。评估患者的种族和收入与约束使用之间的关联，然后评估约束措施本身与包括死亡率在内的临床结局之间的关联。对有和没有定义为存在机械通气、胃管放置和/或中心静脉导管放置的ICD-10编码的侵入性护理的住院患者进行了单独分析。
在228,430例住院患者中，有2.4%的患者记录了约束使用情况。在没有定义侵入性护理的住院患者中，黑人患者的约束使用率高于白人患者（调整后比值比[aOR]=1.57，95%置信区间[CI]1.24-1.98，p<0.001），而低收入与约束使用没有独立关联（全国收入第一四分位数与第四四分位数相比，aOR=0.98，p=0.895）。在不涉及其他定义的侵入性护理的住院患者中，使用身体约束与较高的死亡率相关（aOR=1.71，95%CI 1.20-2.43，p=0.003），而在采用侵入性护理的住院患者中，使用身体约束与死亡率降低相关（aOR=0.55，95%CI 0.40-0.77，p<0.001）。
对于没有其他侵入性护理的肝性脑病住院患者，似乎有必要仔细考虑约束的必要性，因为在这组患者中发现了约束使用方面的社会差异和死亡率增加的情况。
