of children and adolescents with psychiatric
problems has generated controversy. Restraint
may be defined as methods used to restrict movement or normal access to one's body. Published data to guide restraint
practice are limited.
To examine frequency of restraint
use and patient demographics and chief complaints associated with restraint
use in our pediatric emergency department.
We retrospectively reviewed the pediatric emergency department records of children (age <18 years) who underwent emergency psychiatric
evaluation in an urban general hospital from January 2001 to December 2002. Factors associated with restraint
use were determined using multivariate logistic regression.
Data were available for 1125 (82%) of 1371 patients who underwent emergency psychiatric
evaluation; 76 (6.8%) of 1125 patients were restrained: 37 physical
, 19 with medication, and 20 both. Study patients were mean age 13.1 years, 50% girls, 54% blacks, 19% Latinos, and 18% whites; 80% had public insurance. Boys were restrained more often than girls (8.7% vs. 5.2%, P
= 0.02). Age, insurance, and race were not associated with restraint
use. Patients admitted for inpatient psychiatric
care were restrained more frequently than those discharged home (9.9% vs. 3.9%, P
< 0.001). In multivariate logistic regression, sex was not associated with restraint
use was associated with chief complaints of visual hallucinations (odds ratio, 5.29), out-of-control behavior (odds ratio, 4.65), hyperactivity (odds ratio, 2.26), and admission to a psychiatric
facility (odds ratio, 2.40).
Approximately 1 in 15 children undergoing psychiatric
evaluation were restrained. This is the first study to elucidate correlates of restraint
practice in the pediatric emergency department. Further studies examining indications for restraint
and comparing methods of restraint