Mukul Sehgal, MD
University of South Alabama Children's & Women's Hospital
Mobile, Alabama
Disclosure information not submitted.
Kamal Sharma, MD
Assisstant Professor
University of South Alabama Children's & Women's Hospital, United States
Disclosure information not submitted.
Amod Amritphale, MD
Assisstant Professor
University of South Alabama, United States
Disclosure information not submitted.
Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Prashant Jha, MD, DCH, MBBS, FAAP
Assisstant Professor
Children's Hospital of Nevada at UMC, United States
Disclosure information not submitted.
Title: Factors associated with agitation and use of physical restraints in hospitalized children
Background: Physical restraints are commonly used in critical care setting among hospitalized pediatric patients. While initiation of restraints is often a subjective decision, the risk factors associated with increased use of restraints are not completely understood. Given the various ethical and psychological concerns surrounding the use of restraints, it is currently being monitored closely by the Joint commission as a special procedure.
Methods: This study is a retrospective chart review of children admitted to pediatric ICU and floor in a single center in a three-year period from October 2017 to October 2020. Various risk factors, including the demographics and labs indicate those obtained on admission, while the medications represent the ones that were administered at any point during the given hospitalization.
Results: Out of 930 hospitalized children, 132 patients (14.2%) had restraints at some point during the admission. Patients with physical restraints had a longer length of stay (LOS) compared to those without restraints. Median LOS was 4.2 days (IQR: 1.86-27.9) versus 1.41 days (IQR: 0.88-2.94) days (p< 0.001).. Restraint group had a lower hemoglobin level as compared to non-restraint group, median (IQR) [11.8 mg/dl (10.3-13) vs 12.25 (11.1-13.47), p=0.013]. Similarly, patients in restraint group were less likely to use sedation medication like fentanyl [OR = 0.33 (95% CI: 0.11-0.99), p=0.05] and dexmedetomidine [OR = 0.09 (95% CI: 0.05-0.18), p< 0.001]. However, medication like levetiracetam [3.63 (1.63-8.08), p< 0.001] and methylprednisolone [2.38 (1.15-4.91), p= 0.02] were associated with higher use of restraints. Patients who required ventilator use during admission were less likely to be restrained [0.24 (0.09-0.62), p< 0.001]. Use of urinary catheter was associated with decreased use of restraints [0.39 (0.2-0.79), p=0.01]. Medications like
Conclusion: Factors like judicious use of sedation medications and indwelling urinary catheter, as well as treating anemia were associated with decreased of use of restraints. Also use of medications like levetiracetam and methylprednisolone were associated with agitation and increased use of physical restraints among these patients.