title: Use of physical restraints in Dutch intensive care units: a prospective multicenter study.
abstract: BACKGROUND
  Increasing evidence indicates that harmful effects are associated with the use of physical restraint.
  
  
  OBJECTIVE
  To characterize the use of physical restraint in intensive care units. Prevalence, adherence to protocols, and correlates of the use of physical restraint were determined. For comparisons between ICUs, adjustments were made for differences in patients' characteristics.
  
  
  METHODS
  A prospective, cross-sectional, observational multicenter study with a representative sample (n = 25) of all Dutch intensive care units, ranging from local hospitals to academic centers. Each unit was visited twice, and all 379 patients admitted during these visits were included and were examined for use of physical restraint.
  
  
  RESULTS
  Physical restraint was used in 23% of all patients (range, 0%-56% for different units). Of all 346 nurses interviewed, 31% reported using a protocol when applying physical restraint. When corrections were made for clustering within units, the risk for use of physical restraint was increased in patients with delirium or coma, in patients who could not communicate verbally, and in patients receiving psychoactive or sedative medications. Sex, severity of illness, and nurse to patient ratio were not independently related to use of physical restraint. In 11 units (44%), use of physical restraint was more frequent than expected on the basis of patients' characteristics, although this finding was not significant.
  
  
  CONCLUSIONS
  Physical restraint is frequently used in Dutch intensive care units. The differences in frequency between units suggest that opportunities exist to limit the use of physical restraint.
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. a.w.vanderkooi@umcutrecht.nl.
authors.forename: Arendina W
authors.initials: AW
authors.lastname: van der Kooi
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Rosa J
authors.initials: RJ
authors.lastname: Raijmakers
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Renée L
authors.initials: RL
authors.lastname: Vroegop
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Danique F
authors.initials: DF
authors.lastname: Bakker
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Hilâl
authors.initials: H
authors.lastname: Tekatli
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: van den Boogaard
authors.affiliation: Arendina W. van der Kooi is a researcher; Rosa J. Raijmakers, Renée L. Vroegop, Danique F. Bakker, and Hilâl Tekatli are students; and Arjen J.C. Slooter is an intensivist and neurologist, Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Linda M. Peelen is a statistician, Department of Intensive Care Medicine, University Medical Center Utrecht, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht. Mark van den Boogaard is a researcher, Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Arjen J C
authors.initials: AJ
authors.lastname: Slooter
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires