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Prim Care Companion CNS Disord · Nov 2019
Disparities and Variables Associated With Physical Restraint for Acute Agitation in a Nonpsychiatric Emergency Department.
- Zaira Khalid, Michael Fana, Richelle Payea, Kyle Rutledge, Bilal Shah, Furhut Janssen, Neli Ragina, and Stephen J Zyzanski.
- 1000 Houghton Ave, Saginaw, MI 48602. Khali1z@cmich.edu.
- Prim Care Companion CNS Disord. 2019 Nov 21; 21 (6).
ObjectiveTo determine associations between the rate of physical restraint and demographic variables such as body mass index (BMI), ethnicity, sex, and age in the emergency department (ED) along with clinical variables such as various psychiatric diagnoses and medications.MethodsThis 6-month (October 1, 2016-March 30, 2017) retrospective chart review was conducted in the ED of a community hospital, which is also a teaching institution for medical students and residents but does not have access to psychiatry consultations via phone or in person. A total of 165 agitated patients were included in the study. Agitated patients who were restrained were compared to those who were not physically restrained.ResultsOf the patients, 112 (68%) were physically restrained, and those not physically restrained were included as controls (n = 53, 32%). Younger age (P = .03), lower BMI (P = .04), intoxication (P = .001), preexisting diagnosis of depression (P = .02), and antipsychotics as a home medication (P = .03) were associated with physical restraints. In the ED, administration of haloperidol and olanzapine was associated with physical restraints. Current benzodiazepine prescription (P = .001), ED administration of ketamine (P = .001), and ED administration of diazepam (P = .001) were more common in those not physically restrained.ConclusionsRisk factors for physical restraints can be used to identify high-risk patients early, and other treatments along with behavioral and environmental modifications may then be utilized. Further research to develop protocols using nonpharmacologic and pharmacologic measures to minimize use of restraints is required.© Copyright 2019 Physicians Postgraduate Press, Inc.
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