• Aaron E Robinson, Brian E Driver, Jon B Cole, James R Miner, Andrea P Dreyfuss, Aida W Strom, Erik R Brodt, and Thomas E Wyatt.
• 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. Electronic address: aaron.robinson.em.md@gmail.com.
• Ann Emerg Med. 2024 Feb 1; 83 (2): 919991-99.

Study ObjectiveTo determine what patient characteristics were associated with the application of physical restraints in our emergency department (ED).MethodsThis 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.ResultsThere 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.ConclusionsDrug 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.Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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