Pharmacologic Restraint Use During Mental Health Admissions to Children's Hospitals

Pharmacologic Restraint Use During Mental Health Admissions to Children's Hospitals

Primary mental health admissions are increasing across US children's hospitals. These patients may experience agitation requiring pharmacologic restraint. This study characterized pharmacologic restraint use in medical inpatient units by primary mental health diagnosis. This retrospective, cros...

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Bibliographic Details
Published in:Pediatrics (Evanston) Vol. 153; no. 1; p. 1
Main Authors: Masserano, Benjamin, Hall, Matt, Wolf, Ryan, Diedrich, Andrew, Gupta, Ankita, Yu, Andrew G, Johnson, Katherine, Mittal, Vineeta
Format: Journal Article
Language:English
Published: United States American Academy of Pediatrics 01-01-2024
Subjects:
Anxiety disorders
Autism
Child & adolescent mental health
Children
Children & youth
Diagnosis
Eating disorders
Hospitals
Mental health
Patients
Pediatrics
Trends
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Summary:Primary mental health admissions are increasing across US children's hospitals. These patients may experience agitation requiring pharmacologic restraint. This study characterized pharmacologic restraint use in medical inpatient units by primary mental health diagnosis. This retrospective, cross-sectional study used the Pediatric Health Information System database. The study included children aged 5 to 17 years admitted with a primary mental health diagnosis between 2016 and 2021. Rates of pharmacologic restraint use per 1000 patient days were determined for 13 mental health diagnoses and trended over time with Poisson regression. Of 91 898 hospitalizations across 43 hospitals, 3% of admissions and 1.3% of patient days involved pharmacologic restraint. Trends in the rate of pharmacologic restraint use remained stable (95% confidence interval [CI], 0.7-2.1), whereas the incidence increased by 141%. Diagnoses with the highest rates of pharmacologic restraint days per 1000 patient days included autism (79.4; 95% CI, 56.2-112.3), substance-related disorders (45.0; 95% CI, 35.9-56.4), and disruptive disorders (44.8; 95% CI, 25.1-79.8). The restraint rate significantly increased in disruptive disorders (rate ratio [RR], 1.4; 95% CI, 1.1-1.6), bipolar disorders (RR, 2.0; 95% CI, 1.4-3.0), eating disorders (RR, 2.4; 95% CI, 1.5-3.9), and somatic disorders (RR, 4.2; 95% CI, 1.9-9.1). The rate significantly decreased for autism (RR, 0.8; 95% CI, 0.6-1.0) and anxiety disorders (RR, 0.3; 95% CI, 0.2-0.6). Pharmacologic restraint use among children hospitalized with a primary mental health diagnosis increased in incidence and varied by diagnosis. Characterizing restraint rates and trends by diagnosis may help identify at-risk patients and guide targeted interventions to improve pharmacologic restraint utilization.
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content type line 23
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2023-062784