Factors associated with the use of physical restraints for agitated patients in psychiatric emergency rooms.
OBJECTIVE
To examine factors associated with physical restraint in psychiatric emergency rooms.


METHODS
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.


CONCLUSIONS
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.
Migon
Marcelo N
MN
Department of Mental Health, Duque de Caxias General Hospital, Duque de Caxias, Rio de Janeiro, Brazil.
Coutinho
Evandro S
ES
Huf
Giselle
G
Adams
Clive E
CE
Cunha
Geraldo M
GM
Allen
Michael H
MH
D000328:Adult; D000374:Aggression / Q000187:drug effects / Q000523:psychology*; D001499:Bayes Theorem; D001938:Brazil; D004359:Drug Therapy, Combination; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011398:Promethazine / Q000009:adverse effects / Q000627:therapeutic use; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy; D014149:Tranquilizing Agents / Q000009:adverse effects / Q000627:therapeutic use; D014600:Utilization Review / Q000706:statistics & numerical data
D014149:Tranquilizing Agents; D011398:Promethazine; D006220:Haloperidol; D008874:Midazolam