Factors associated with the use of physical restraints for agitated patients in psychiatric emergency rooms.

Author(s): Migon MN, Coutinho ES, Huf G, Adams CE, Cunha GM, Allen MH

Affiliation(s): Department of Mental Health, Duque de Caxias General Hospital, Duque de Caxias, Rio de Janeiro, Brazil.

Publication date & source: 2008-05, Gen Hosp Psychiatry., 30(3):263-8.

Publication type: Comparative Study; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

OBJECTIVE: To examine factors associated with physical restraint in psychiatric emergency rooms. METHOD: We extracted variables likely to predict use of physical restraints from a large randomised trial undertaken in three psychiatric emergency rooms in Rio de Janeiro. We fitted a Bayesian binary multivariate model using only variables clearly preceding the restraints. RESULTS: Of 301 agitated, aggressive people admitted to emergency rooms, 73 (24%) were restrained during the first 2 h of admission. In Rio, younger people (OR=1.03 for each year younger), exhibiting intense (OR=2.53) or extreme agitation (OR=7.71), thought to result from substance misuse (OR=1.75) or diagnoses other than psychosis (OR=1.88), arriving in the morning (OR=1.64) were at greater risk of physical restraints than older, less severely aggressive or agitated people, arriving at the hospital during the afternoon or night. Hospital, gender, first admission to hospital and medication were not associated with risk of being restrained. CONCLUSION: Restraint practices in Rio are predictable and based on a limited clinical assessment. Predictive factors for physical restraint may vary worldwide, but should be monitored and studied to assist training, and to establish programs to evaluate and refine this controversial practice.